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

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

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

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

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

Bortezomib is a proteasome inhibitor used for the treatment of patients with multiple myeloma. Recently, several case reports about acute pancreatitis caused by Bortezomib were published in the international literature. But Bortezomib induced pancreatitis case was not reported in Korea. Herein, we report a case of acute pancreatitis caused by Bortezomib therapy in a 76-year-old female with multiple myeloma. On three months after the first administration of Bortezomib, the patient visited the hospital with symptoms of acute pancreatitis. The common etiological factors for acute pancreatitis were all excluded. Then the patient was diagnosed as Bortezomib-induced pancreatitis. After cessation of Bortezomib, she showed clinical and laboratory improvement.
Aged ; Female ; Humans ; Korea ; Multiple Myeloma* ; Pancreatitis* ; Proteasome Inhibitors ; Bortezomib

BACKGROUND/AIMS: The purpose of this study was to assess the correlation between histologic activity and fibrosis and the distribution of intrahepatic hepatitis B core antigen (HBcAg) and surface antigen (HBsAg) in patients with chronic hepatitis B. METHODS: 141 patients (M:F=141:27) with biopsy-proven chronic hepatitis B, abnormal liver function, and a positive HBV viral marker (serum HBeAg, serum HBV DNA) were enrolled. RESULTS: HBcAg was expressed in 96 of 141 patients (68.1%), nHBcAg in 23 (16.3%), cHBcAg in 58 (41.2%), and n-cHBcAg in 15 (10.6%). In the cases of HBsAg, 114 of 141 patients (80.9%) were expressed as cHBsAg, 2 (1.4%) as mHBsAg, and 16 (11.3%) as m-cHBsAg. The presence of intrahepatic HBcAg and HBsAg according to Gudat's classification was not correlated with activity and fibrosis. But the groups with nuclear expression of HBcAg revealed less inflammatory activity (grade, p=0.003), and less fibrotic stage (p = 0.002) than with cytoplasmic or no expression of HBcAg. HBsAg was not. CONCLUSIONS: These observations suggest that inflammatory activity and fibrosis of chronic hepatitis B are related to the presence of HBcAg in hepatocytes and the expression of HBcAg. This is a very important finding in hepatocytolysis.
Antigens, Surface ; Biomarkers ; Classification ; Cytoplasm ; Fibrosis* ; Hepatitis B Core Antigens* ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens* ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Hepatocytes ; Humans ; Immunohistochemistry ; Liver

PURPOSE: Recent and numerous studies have indicated that cardiac biomarker elevation during acute pulmonary embolism (PE) predicts in-hospital death. However, the role of cardiac biomarkers for predicting the occurrence of hypotension is unknown. The aim of the present study was to evaluate whether increased levels of cardiac biomarkers can predict the occurrence of hypotension (sytolic blood pressure (SBP) <90 mmHg) within 24 hours in non-high-risk patients with acute PE. METHODS: Study subjects included all consecutive patients with acute PE, as diagnosed by chest computed tomographic angiography, in the emergency department (ED) from January 2009 through December 2011. All patients underwent tests for troponinI (TnI), creatinine kinase-MB isoenzyme (CK-MB), and brain natriuretic peptide (BNP) levels upon ED admission and were divided into two groups based on the occurrence of hypotension within 24 hours. RESULTS: Out of 196 stable patients with acute PE admitted to the ED during the study period, 154 patients were included. Within 24 hours of hospitalization, 13 (8.4%) patients developed hypotension. The mean values for serum TnI, CK-MB, and BNP were significantly higher in patients who developed hypotension than in patients who did not. The TnI value was the most accurate biomarker for predicting the occurrence of hypotension. Moreover, elevated levels of cTnI (>0.05 ng/mL) upon admission were an independent predictor for developing hypotension within 24 hours in patients with stable acute PE at the time of ED admission (odds ratio 11.0, 95% confidence interval (CI) 2.8-43.8, p=0.00). CONCLUSION: In stable patients with acute PE, an elevated TnI can predict the in-hospital development of hypotension within 24 hours. This finding is valuable for selecting patients who might benefit from intensive clinical surveillance and escalated treatment.
Angiography ; Biomarkers ; Blood Pressure ; Creatinine ; Emergencies ; Hospitalization ; Humans ; Hypotension ; Natriuretic Peptide, Brain ; Pulmonary Embolism ; Thorax ; Troponin