BACKGROUND: Peripheral artery disease (PAD), which is caused by atherosclerosis of the peripheral vessels, is a progressive disease, especially in patients with many of the vascular risk factors. The aim of this study was to investigate the prevalence and risk factors of PAD in elderly chronic stage ischemic stroke patients in Korea. METHODS: Ninety-six elderly patients (> or =60 years) admitted to a local geriatric hospital with ischemic stroke in the chronic stage (mean duration of stroke, 590 days) were included in this study. Vascular risk profiles, routine blood tests, severity of stroke and ankle-brachial index (ABI) were measured. RESULTS: Of the 96 patients, 55 (57.3%) had PAD (ABI<0.9) of which 6 patients (6.3%) had severe PAD (ABI<0.5) and 22 patients (22.9%) had bilateral PAD. PAD was more frequently observed in patients with diabetes (65% vs. 15%, p=0.001), hypercholesterolemia (65% vs. 15%, p<0.001), previous history of coronary artery disease (CAD) (25% vs. 5%, p=0.01) and recurrent ischemic stroke (36% vs. 12%, p=0.01). The means of the total cholesterol and blood urea nitrogen were higher in patients with PAD. From the results of the binary logistic regression analysis, presence of diabetes (odds ratio [OR], 4.740; p=0.026), hypercholesterolemia (OR, 18.991; p<0.001), previous history of CAD (OR, 7.579; p=0.038) and lower Korean version of Modified Barthel Index (OR, 0.971; p=0.009) were independent risk factors for PAD. CONCLUSION: PAD is frequently observed in elderly patients with chronic ischemic stroke. Measuring ABI to diagnose PAD and controlling risk factors may be beneficial in these patients seen at geriatric hospitals and centers.
Aged ; Ankle Brachial Index ; Atherosclerosis ; Blood Urea Nitrogen ; Cerebral Infarction ; Cholesterol ; Coronary Artery Disease ; Hematologic Tests ; Humans ; Hypercholesterolemia ; Logistic Models ; Peripheral Arterial Disease ; Prevalence ; Risk Factors ; Stroke

OBJECTIVE: The supply of emergency medicine (EM) specialists has not been able to meet demand in the past decade. This study comparatively analyzed clinical findings to provide fundamental data to inform efficient utilization of a limited number of EM specialists. METHODS: This retrospective study included 54,204 patients who visited the emergency department of a tertiary care medical center from March 1 to December 31, 2012. The experimental specialist-supervised (SS) group included patients supervised by an EM specialist, while the control specialist-on-call (SOC) group included patients attended by a senior resident of EM with an EM specialist on call. RESULTS: The mean length of stay in the emergency department was longer in the SS group than in the SOC group for all levels of severe-to-moderate (levels 1 to 3) and mild (levels 4 and 5) patient conditions (P<0.05). The mortality rate of severe-to-moderate patients in the SOC group was 1.63 times higher than that in patient in the SS group. CONCLUSION: Supervision by EM specialists significantly decreased mortality in patients with severe-to-moderate condition. Therefore, EM specialists should focus on this patient group, while training residents should concentrate on patients with relatively mild conditions.
Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital* ; Humans ; Length of Stay ; Medical Staff ; Mortality ; Organization and Administration ; Retrospective Studies ; Specialization* ; Tertiary Healthcare

PURPOSE: Hospital disaster plans usually involve evacuation of hospital patients, including discharge or transfer to non-affected hospitals or facilities. However, this is difficult in cases of isolated hospitals. Disaster plans for isolated hospitals, therefore, must account for the preparation of supplies that will allow survival of their patients when transfer is impossible. The aim of this study was to assess the disaster supply preparedness of isolated hospitals in Korea. METHODS: We surveyed hospitals to assess various aspects of their disaster preparedness: drinking water, food, fluids, wound dressing sets, suture sets, shelter, emergency generator systems, triage systems, and communication equipment. Preparedness was compared between hospitals according to their emergency department (ED) level. RESULTS: We obtained complete data from 71 EDs of the 118 hospitals having emergency medical centers. Less than one fourth of these 71 EDs had reserve water (12.7%), food (7.0%), fluids (23.9%), dressing sets (21.1%), suture sets (21.1%) available for 3 days and emergency flashlights (4.2%), emergency blankets (16.9%), or portable oxygen tanks (4.2%) available enough during a disaster. Sixty-six EDs (93.0%) had emergency electric power, but independent EMC emergency electric power was available in only 7 (9.9%). A very small number of EDs had radiation detectors (15.5%), air shelters (11.3%), or decontamination tents (12.7%), with regional and specialized EMCs much more likely to have such supplies available than were local EMCs (p=0.008, 0.009, < 0.001, respectively). CONCLUSION: This study provides preliminary nation-wide survey data for disaster preparedness of isolated hospitals in Korea. At present, EDs in the vast majority of isolated hospitals are insufficiently prepared with supplies and equipments to cope with emerging threats during a disaster.
Bandages ; Decontamination ; Disaster Planning ; Disasters ; Drinking Water ; Emergencies ; Equipment and Supplies ; Humans ; Korea ; Oxygen ; Phosphatidylethanolamines ; Sutures ; Triage ; Water

OBJECTIVE: This study was designed to describe how to develop the 'ASAN-Drug Allergy Alert System' and evaluate the usefulness of this system. METHODS: The drug allergy alert system was developed by a task force that was consisted of emergency physicians, pharmacists, and programmers for ten months. Since this system had been implemented, we compared frequencies with a previous paper based system. RESULTS: This system was implemented with three stages: an input stage, a censorship stage, and an alertness stage. The input of data was done by physicians and nurses as a multidisciplinary team. The censorship of data was charged of an allergist who confirmed whether a suspicious drug had caused life threatening symptoms or not. If the causative drug was confirmed by an allergist, an alert sign changed 'Code Yellow' to 'Code Red' automatically. After that censorship, an alert sign was noticed to clinicians as a yellow or red colored pop-up window. After an alert system, frequencies per month of report were increased from 44.6 to 594. Also, the report ratio of life threatening symptoms was increased from 5.4% to 12.5% (p<0.001). CONCLUSION: We assumed that the Asan-Drug Allergy Alert System could reduce medication errors effectively.
Advisory Committees ; Chungcheongnam-do* ; Drug Hypersensitivity* ; Emergencies ; Humans ; Hypersensitivity ; Medication Errors ; Pharmacists

As extra-mammary Paget's disease is rare and usually diagnosed at early stage when it is highly curable with surgical resection, it is much rarer to see patients with recurrent metastatic disease. Thrombotic thrombocytopenic purpura in patients with metastatic solid cancer is also a rare disease and may result from bone marrow metastasis or bone marrow necrosis. For the latter, the majority of cases are not eligible for systemic chemotherapy for rapid disease progression and poor performance status. Herein, authors report a patient with thrombotic thrombocytopenic purpura associated with bone marrow necrosis complicating extra-mammary Paget's disease who was successfully treated with docetaxel and carboplatin combination chemotherapy.
Bone Marrow* ; Carboplatin ; Disease Progression ; Drug Therapy ; Drug Therapy, Combination ; Humans ; Necrosis* ; Neoplasm Metastasis ; Paget Disease, Extramammary* ; Purpura, Thrombotic Thrombocytopenic* ; Rare Diseases

BACKGROUND: While aspirin sensitivity has been known to be common among patients with severe asthma, its frequency among asthmatics with mild to moderate severity remains to be learned. OBJECTIVES: To elucidate the frequency of aspirin sensitivity and its clinical characteristics among asthma patients with mild to moderate severity. MATERIAL AND METHODS: A total of 96 asthmatics with mild to moderate severity were enrolled. They underwent lysine-aspirin and methacholine bronchial provocation tests, and gave their induced sputum after the lysine-aspirin challenge. RESULTS: FEV1 declined greater than 20% compared with baseline FEV1 in 11 of 96 patients on the lysine-aspirin challenge. The frequency of aspirin sensitivity was higher among patients with enhanced bronchial hyperresponsiveness to methacholine (PC20 < 1 mg/ml) than among those without it (27.3% vs. 6.8%). The frequency was also higher in those with induced sputum eosinophil count higher than 3% than among those without it (38.9% vs. 0%). However, it was not associated with other risk factors such as age, sex, atopy, nasal polyps, and rhinosinusitis. CONCLUSION: More than 10% of mild to moderate asthmatics have aspirin sensitivity even though they have experienced no history of aspirin sensitivity which may be related with bronchial hyperresponsiveness to methacholine and eosinophil activation.
Aspirin* ; Asthma ; Asthma, Aspirin-Induced ; Bronchial Provocation Tests ; Eosinophils ; Humans ; Methacholine Chloride ; Nasal Polyps ; Prevalence* ; Risk Factors ; Sputum

Dengue fever is an acute febrile disease caused by the dengue virus, which belongs to the flaviviridae family, and this virus is transmitted by the bite of the mosquito Aedes aegypti. It occurs in the tropical climates of the South Pacific, Southeast Asia, India, Africa and the subtropical zone of America. Imported cases of Dengue fever and Dengue hemorrhagic fever are rapidly increasing as many Koreans are now traveling abroad. Liver injury is usually detected by laboratory investigation according to a surveillance protocol. Although liver injury by dengue virus has been described in Asia and the Pacific islands, the pathogenic mechanisms are not yet fully clarified. It is usually expressed in a self-limiting pattern and the patient has a complete recovery. We report here on a case of a young woman who presented with general weakness, nausea and significant elevation of the aminotransferase levels, and she was diagnosed with dengue fever.
Acute Disease ; Adult ; Dengue Hemorrhagic Fever/complications/*diagnosis/virology ; Dengue Virus/*isolation & purification ; Female ; Hepatitis, Viral, Human/*diagnosis/virology ; Humans

Controlling balance between T-helper type 1 (Th1) and T-helper type 2 (Th2) plays a pivotal role in maintaining the biological rhythm of Th1/Th2 and circumventing diseases caused by Th1/Th2 imbalance. Interleukin 4 (IL-4) is a Th2-type cytokine and often associated with hypersensitivity-related diseases such as atopic dermatitis and allergies when overexpressed. In this study, we have tried to elucidate the function of 1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol (EC-18) as an essential modulator of Th1/Th2 balance. EC-18 has showed an inhibitory effect on the production of IL-4 in a dose-dependent manner. RT-PCR analysis has proved EC-18 affect the transcription of IL-4. By analyzing the phosphorylation status of Signal transducer and activator of transcription 6 (STAT6), which is a transcriptional activator of IL-4 expression, we discovered that EC-18 induced the decrease of STAT6 activity in several stimulated cell lines, which was also showed in STAT6 reporter analysis. Co-treatment of EC-18 significantly weakened atopy-like phenotypes in mice treated with an allergen. Collectively, our results suggest that EC-18 is a potent Th2 modulating factor by regulating the transcription of IL-4 via STAT6 modulation, and could be developed for immune-modulatory therapeutics.
Animals ; Cell Line ; Dermatitis, Atopic ; Hypersensitivity ; Interleukin-4* ; Mice ; Phenotype ; Phosphorylation ; STAT6 Transcription Factor

PURPOSE: This study examined the changes in intracavernous pressure, expression of nitric oxide synthase(NOS), and content of penile smooth muscle in castrated rats and testosterone-supplied castrated rats. MATERIALS AND METHODS: Sprague Dawley rats were used for this study and divided into control, castrated, and testosterone-supplied castrated groups. Castration was performed by bilateral orchietomy under general anesthesia, and testosterone propionate 3 mg/kg was injected subcutaneously daily for a week beginning 4 weeks after orchiectomy. Intracavernous pressure was measured by stimulating the cavernous nerve at 10 volts, 2.4 mA. Expression of NOS was measured by immunohistochemical staining for NADPH diaphorase, and content of penile smooth muscle was measured by H&E staining of the corpus cavernosum. The stained area-to-tissue ratio was calculated by computer scanning for each case. RESULTS: Compared with the control group(3.45+/-0.25 ng/ml), the serum testosterone level of the castrated group (0.78+/-0.34 ng/ml) was lower. Serum testosterone level was restored in the testosterone-supplied castrated group. Compared with the(67.2+/-14.3 cmH2O) was decreased (p <0.05). There was no significant difference between the testosterone-supplied group(94.7+/-11.4 cmH2O) and control group, so intracavernosal pressure was restored by testosterone treatment. Immunohistochemical staining for NOS showed that NADPH diaphorase was stained as brown nerve fiber. Compared with the control group(37.5+/-2.8%), the NOS activity of the castrated group(7.5+/-2.1%) was significantly decreased(p <0.05). NOS activity was slightly increased in the testosterone-supplied group(47.5+/-2.4%) compared with the control group, but the difference was not statistically significant. Thus, testosterone treatment restored NOS activity after castration. By H&E staining, the content of penile smooth muscle was 76.5+/-2.8% in the control group, but significantly lower in the castrated group(46.2+/-3.4% p <0.05). Smooth muscle content was slightly decreased in the testosterone-supplied group(63.8+/-4.7%) compared with control group, but the difference was not statistically significant. Thus, smooth muscle content was restored by testosterone treatment after castration. CONCLUSIONS: Decline of factors involved in erectile function can be restored by testosterone replacement after castration.
Anesthesia, General ; Animals ; Castration ; Male ; Muscle, Smooth ; NADPH Dehydrogenase ; Nerve Fibers ; Nitric Oxide ; Orchiectomy ; Penile Erection* ; Rats* ; Rats, Sprague-Dawley ; Testosterone Propionate ; Testosterone*

Hepatocellular carcinoma is one of the most common malignancies reported in Korean adult males. Hepatocellular carcinoma usually spreads to regional lymph nodes around porta hepatis via lymphatics and to distant metastasis via hematogenous spread. The lung is most common distant metastatic site, followed by the adrenal glands, local lymph nodes and bones. But metastasis to the spinal cord of hepatocellular carcinoma is very rare. Recently we experienced a patient with hepatocellular carcinoma who had suffered from lower leg weakness for 10 days. The patient was proved to have hepatocellular carcinoma with metastasis to the spinal cord. MRI showed an ovoid intracordal mass between the twelfth thoracic and first lumbar vertebra level. After emergency irradiation, the patient could recover.
Carcinoma, Hepatocellular/*secondary ; English Abstract ; Human ; Liver Neoplasms/*pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord Neoplasms/diagnosis/*secondary