Objective: Emergency department (ED) overcrowding is a global issue that negatively impacts the clinical outcome. Through the coronavirus disease 2019 (COVID-19) pandemic era, overcrowding of ED isolated territory (isolation bed) was aggravated. This study analyzed overcrowding indices of ED isolation beds during the COVID-19 pandemic. Methods: This study was a single-center, retrospective, observational study. The study analyzed 34,925 patients who visited the ED during the COVID-19 pandemic from April 2021 to August 2022. Patients who were treated in isolation beds and regular beds were compared. Among the patients using isolation beds, patients who stayed longer than 720 minutes were also classified and analyzed. Results: During the analysis period, 4,479 and 34,943 patients were treated in the ED isolation bed and ED regular bed, respectively. The overcrowding indices (general ward admission rate, intensive care unit admission rate, ED-length of stay, transfer rate, mortality rate, prolonged ED stay patient ratio) of the isolation beds were significantly higher than those of the ED regular bed (P<0.05). The prolonged ED stay-patient ratio of isolation beds and regular beds was affected by the number of COVID-19 patients (regular bed, r=0.617 and P=0.01; isolation bed, r=0.525 and P=0.03). The average ED-length of stay of isolation beds was longer than that of the ED regular beds. One hundred and forty-five patients were classified as prolonged ED stay patients. Their time from the decision point to the discharge point comprised a higher rate with an average of 76.52%. Conclusion ED isolation beds are more vulnerable to infectious disease outbreaks. A proper medical policy and arrangement management system that can flexibly deal with disaster emergencies are required

PURPOSE: Human papillomavirus (HPV) infection is a well-known cause of cervical cancer, which, along with its precursors, can be diagnosed and treated with cervical conization (CC). This study aimed to assess HPV- and procedure-related knowledge among women who had undergone CC. MATERIALS AND METHODS: Between February and May 2014, consecutive women who had undergone CC at five different educational hospitals were recruited. All patients had undergone a loop electrosurgical excision procedure as the method of CC. A survey was conducted with a self-developed, 29-item questionnaire, measuring knowledge related to HPV and CC. We analyzed the responses of 160 patients who completed the questionnaire. RESULTS: Mean total knowledge scores (±standard deviation) for HPV and CC were 5.2±3.0 of a possible 13.0 and 8.3±4.2 of a possible 16.0, respectively. While 73% of the patients knew that HPV is the main cause of cervical cancer, only 44% knew that HPV is sexually transmitted. The purpose of CC was correctly identified by 71% of the patients. However, 35% failed to indicate the anatomical area resected at the time of CC in the schematic diagram. Women who were younger (p<0.001), had higher education level (p<0.001), and higher family income (p=0.008) had higher knowledge scores. In contrast, neither interval from CC to survey nor disease severity were associated with total knowledge score. CONCLUSION: The level of knowledge related to HPV and CC was unexpectedly low in women who had undergone CC. Intuitive educational resources may improve this knowledge, and further cohort studies are warranted.
Adult ; Cervix Uteri/*pathology/*virology ; *Conization ; Female ; *Health Knowledge, Attitudes, Practice ; Humans ; Middle Aged ; Papillomaviridae/*physiology ; Republic of Korea ; Sexual Behavior ; *Surveys and Questionnaires ; Uterine Cervical Neoplasms/virology ; Young Adult

We report a case of anal squamous cell carcinoma extended to the rectal mucosa that was clinically mistaken for rectal adenocarcinoma and literature reviwed. Sigmoidoscopic finding showed spherical shaped elevated lesion with central ulceration, interpreted as rectal adenocarcinoma in the distal portion of rectum. Anal squamous cell carcinoma is very rare among gastrointestinal cancer. Pathological study of the biopsy specimen demonstrated squamous cell carcinoma and normal rectal glands. Sigmoidoscopic finding of the presented case showed the ulcerarive lesion contineuosly extended from anal verge upward to the rectum. We postulate that the presented case is primarilly originated from the anal squamous cell carcinoma extended proximally to the rectum. Immunohistochemical stain(p-63) of the biopsy specimens showed squamous cell carcinoma. This patient has been completely recovered after treartment of chemoradiation and trans-anal excision. We present a case of anal squamous cell carcinoma invading rectal mucosa clinically mistaken for rectal adenocarcinoma and literature reviewed.
Adenocarcinoma* ; Anus Neoplasms ; Biopsy ; Carcinoma, Squamous Cell* ; Gastrointestinal Neoplasms ; Humans ; Mucous Membrane ; Rectum ; Salt Gland ; Ulcer

IgG4-related sclerosing disease is a novel clinical disease entity characterized by an elevated serum IgG4 concentration and tissue infiltration by IgG4-positive plasma cells. Although this disease is a novel entity, it is not rare and is present in a proportion of patients with a wide variety of diseases, including autoimmune pancreatitis, sclerosing cholangitis, retroperitoneal fibrosis, and inflammatory pseudotumor. Despite the effectiveness of steroid therapy, IgG4-related sclerosing disease is often misdiagnosed as a malignant tumor. Here, we report an inflammatory pseudotumor of the great omentum that was misdiagnosed as a malignant tumor and subject to surgical resection.
Cholangitis, Sclerosing ; Granuloma, Plasma Cell ; Humans ; Immunoglobulin G ; Omentum ; Pancreatitis ; Plasma Cells ; Retroperitoneal Fibrosis

Sarcomatoid carcinoma or carcinosarcoma is a very rare biphasic tumor characterized by a combination of malignant epithelial and mesenchymal cells. The pathogenesis of sarcomatoid carcinoma is not fully elucidated and the guideline of treatment has not been established yet. Although the upper aerodigestive tract, lung and female urogenital system are known to be the most frequently affected, this tumor also can occur in various sites, including the digestive tract. Since sarcomatoid carcinoma in colon was firstly reported in 1986, 24 cases have been reported to date. We report a rare case with sarcomatoid carcinoma of appendix. Interesting histologic feature of our case was the presence of mucinous cystadenocarcinoma with morphological "transition" between carcinomatous and sarcomatous tissue. To our knowledge, this is the first case of sarcomatoid carcinoma arising from mucinous cystadenocarcinoma of the appendix.
Appendix ; Carcinosarcoma ; Colon ; Cystadenocarcinoma, Mucinous ; Female ; Gastrointestinal Tract ; Humans ; Lung ; Mucins ; Urogenital System

PURPOSE: Colorectal resection for elderly patients is associated with significant morbidity and mortality. It is still unclear whether or not laparoscopic colorectal resection (Lap CR) is indicated in elderly patients. The aim of this study is to evaluate the outcome of colonic surgery in elderly patients and to assess the feasibility and safety of laparoscopic colorectal surgery in elderly patients. METHODS: Patient characteristics and perioperative and pathologic data on 295 patients who underwent Lap CR for cancer from Jan. 2004 to Aug. 2011 were prospectively collected. Exclusion criteria were emergency and palliative by-pass surgery. Outcomes for elderly patients (> or =75 years) were compared with those of younger patients (<75 years). RESULTS: In comparison of 257 younger patients (<75 years, median age 61 years), 38 elderly patients (> or =75 years, median age 79 years) showed a greater proportion off emale gender (52.6% vs. 37.0%, p=0.065) and American Society of Anesthesiologists score 2~3 (97.3% vs.42.0%, p<0.001). No differences in tumor location, median operative time, conversion rate, duration of hospital stay, and perioperative complications (23.7% vs. 30.0%, p=0.427) were observed between the two groups. Distributions of American Joint Committee on Cancer stages and number of harvested lymph nodes were comparable between groups. CONCLUSION: Although elderly patients are more likely to be affected by co morbidities, postoperative outcome in this group after Lap CR is comparable with that of younger patients. Use of Lap CR in elderly patients is safe, and is associated with a low morbidity. It should be also regarded as the optimal approach for very elderly patients.
Aged ; Colon ; Colorectal Neoplasms ; Colorectal Surgery ; Emergencies ; Humans ; Joints ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Prospective Studies

BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality in kidney transplantion recipients. Enhanced cardiac load by the persistence of functioning AVF in posttransplant period is associated with LV hypertrophy and may adversely influence cardiac outcome. METHODS: To investigate the impact of AVF on LV mass and function in kidney transplant recipients, 46 patients with functioning AVF were randomly assigned to surgical closure of AVF (fistular closing group, FC, n=23) or maintenance of fistula (fistular maintenance group, FM, n=23). Serum creatinine of all participants was stable(1.4+/-0.3). Mean age was 46+/-11. Mean posttransplant month was 78+/-53 (12-161). Echocardiography and determination of N-terminal pro-BNP, cTnT and CRP were done at 0, 1 and 6 months in group 1 (FC), and at 0 and 6 months in group 2 (FM). RESULTS: Baseline echocardiographic indices of systolic and diastolic LV function such as EF, E/A, E/E' and Tei index were not significantly different between groups. In patients whose AVF was surgically closed, LV mass (247.7+/-76.8 to 235.2+/-66.5, p=0.015) and LV mass index (144.0+/-10.1 to 137.1+/-8.6, p=0.02) significantly reduced at one month after closure, and no further significant change was observed at 6 months. In two groups no significant change in LV systolic and diastolic performance indices were observed. BNP, cTnT and CRP did not differ between groups in baseline value and did not change after closure. CONCLUSION: We conclude that the persistence of functioning AVF in kidney transplantation recipients is associated with LVH, and which can be reduced by closure of fistula. As LVH is one of major determinants of cardiovascular outcome in transplant patients as well as in general population, it would be prudent to close the fistula in patients with stable graft function.
Arteriovenous Fistula* ; Cardiovascular Diseases ; Creatinine ; Echocardiography ; Fistula ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Kidney Transplantation* ; Kidney* ; Mortality ; Transplantation ; Transplants

The myocardial bridge of the coronary arteries is observed by coronary angiography at a rate of <5 % and ordinarily does not constitute a hazard. Occasionally, the compression of a coronary artery by a myocardial bridge can be associated with the clinical manifestations of myocardial ischemia during strenuous physical activity and might even result in a myocardial infarction or initiate malignant ventricular arrhythmias. A few cases of percutaneous coronary intervention for a myocardial bridge have been reported. However, there are few reports of the changes in the 2-dimensional strain in the myocardial bridge. We encountered a case of a myocardial bridge in a 48-year-old male patient who had refractory angina despite continuous medication with a beta-blocker and calcium channel blocker. The 2-dimensional strain of the patient changed after percutaneous coronary intervention with stents. We report the first case in Korea with a review of the relevant literature.
Arrhythmias, Cardiac ; Calcium Channels ; Coronary Angiography ; Coronary Vessels ; Humans ; Korea ; Male ; Middle Aged ; Motor Activity ; Myocardial Infarction ; Myocardial Ischemia ; Percutaneous Coronary Intervention* ; Stents

BACKGROUND AND OBJECTIVES: We wanted to perform quantitative echocardiographic assessment of myocardial function in the patients with myocardial bridge by measuring 2-dimensional strain with using newly developed software. SUBJECTS AND METHODS: Novel computer software was used for tracking heart tissue on echocardiography, and we conducted an advanced wall-motion analysis for 18 symptomatic patients (mean age: 57.1+/-9.7 years, 10 female) with myocardial bridging of the left anterior descending coronary artery and also 20 age-matched healthy controls. The conventional wall-motion scoring was normal in all the patients, and the software was able to adequately track their heart tissue. RESULTS: The maximal angiographic systolic lumen diameter reduction within the myocardial bridges was 71+/-12.6% at rest, with a persistent diameter reduction of 31.2+/-11.3%. The radial strain and displacement of the anterior segments were more significantly reduced than that of the posterior segments at the level of the papillary muscle (30.9+/-13.8% vs. 51.8+/-17.3% and 4.8+/-0.9 vs. 5.9+/-1.5, respectively, all p<0.05), and this showed a plateau (39% and 33%, respectively) or biphasic (50% and 56%, respectively) pattern. The time from the R wave on electrocardiography to the transition from regional systole to early diastolic lengthening (Tr) was significantly delayed in the patients with myocardial bridge more than that for the controls (497+/-20.4 ms vs. 348+/-12.5 ms, respectively, p<0.05). CONCLUSION: Delayed systolic contraction and diastolic relaxation are important mechanisms that contribute to ischemia in the patients with myocardial bridge. 2-dimensional strain can be used to achieve real-time wall-motion analysis, and it has the potential to improve the identification and functional quantification of myocardial Bridge.
Coronary Vessels ; Echocardiography ; Electrocardiography ; Heart ; Humans ; Ischemia ; Myocardial Bridging ; Papillary Muscles ; Relaxation ; Systole ; Ventricular Function, Left*

BACKGROUND AND OBJECTIVES: Because hypertension and left ventricular hypertrophy (LVH) frequently coexist with diabetes, in this study we sought to compare the myocardial functional and structural changes in diabetic patients who were with or without hypertension with those myocardial functional and structural changes in non-diabetic subjects with hypertension (essential hypertension), in order to identify the role of diabetes alone, in relation to the myocardial dysfunction. SUBJECTS AND METHODS: We studied 50 patients with essential hypertension (HTN, 20 men and 30 women; mean age: 59+/-12 years), 54 diabetes mellitus patients without hypertension (DM, 24 men and 30 women; mean age: 60+/-9 years), 53 diabetes mellitus patients with hypertension (DM+HTN, 23 men and 30 women; mean age: 61+/-7 years), and 49 normal subjects (22 men and 27 women; mean age: 56+/-13 years). We used echocardiography that was comprised of the standard 2-dimensional and conventional Doppler imaging for estimating the left ventricular mass index (LVMI), the relative wall thickness (RWT) and the Doppler-derived myocardial performance index (MPI, Tei index). Subjects were considered to have normal geometry (NG) if both the LVMI and RWT were normal (LVMI < or = 104 g/m2 in females, LVMI < or = 116 g/m2 in males, RWT < or = 0.43), concentric hypertrophy (CH) if both were elevated, eccentric hypertrophy (EH) if the LVMI was elevated and the RWT was normal, and concentric remodeling (CR) if the LVMI was normal and the RWT was elevated. RESULTS: The Tei index was significantly higher in the patients with essential hypertension and diabetes, especially in the DM+HTN group (HTN=0.48+/-0.13; DM=0.41+/-0.09; DM+HTN=0.53+/-0.11), as compared to the controls (0.31+/-0.11, p<0.05). The LVMI and RWT were significantly higher in the patients with essential hypertension and diabetes, and especially in the DM+HTN group (HTN=132.2+/-44.4 g/m2 and 0.45+/-0.11; DM=125.9+/-34.4 g/m2 and 0.44+/-0.07; DM+HTN=153.9+/-42.9 g/m2 and 0.48+/-0.07), as compared to the controls (108.9+/-22.2 g/m2 and 0.39+/-0.05, p<0.05). CONCLUSION: Our study demonstrated the early appearance of adverse myocardial functional and geometric changes in the diabetic patients, and the study also showed that the contributory effects of diabetes to the myocardial impairment and LV hypertrophy were produced by the presence of hypertension. The Tei index is a very sensitive method for the detection and evaluation of myocardial impairment in diabetic patients.
Diabetes Mellitus ; Echocardiography ; Female ; Humans ; Hypertension* ; Hypertrophy ; Hypertrophy, Left Ventricular ; Male