BACKGROUND: Diabetic ketoacidosis(DKA) is serious acute metabolic complication and the most important cause of high morbidity and mortality of diabetes. The object of this study is to examine the clinical characteristics of patients with DKA who had a prior history of diabetes or not. METHOD: Authors reviewed retrospectively the medical records of 49 cases adimitted to Kyungpook National University Hospital from January 1991 to June 1997 with a diagnosis of DKA and classified cases as type I, type II and newly diagnosed diabetics according to prior history of diabetes. RESULTS: 1. Of 49 cases of DKA, 24(49%) were classified as type I, 17(35%) as type II from data available in the medical records, and 8(16%) had DKA as the initial manifestation of the disease. 2. The male to female ratio was 0.5 : 1 in type I, 1.1 : 1 in type II and 1.7 : 1 in newly diagnosed diabetics, and the mean age was 24.4 in type I, 57.9 in type II and 23.9 years old in newly diagnosed diabetics. 3. The mean duration between initial diagnosis of diabetes and the occurrence of DKA was 2.6 in type I and 6.9 years in type II diabetes. The occurrence of DKA within 2 years of initial diagnosis of diabetes was 54% in type I and 18% in type II diabetes, but the occurrence of DKA after 5 years of initial diagnosis of diabetes was 17% in type I and 47% in type II diabetes. 4. The precipitating factors of DKA were identified in 88% in type I, 76% in type II and 38% in newly diagnosed diabetics, and the most common precipitating factor was omission of treatment in both type I and type II(type I: 56%, type II: 35%). 5. The altered mental status was correlated with increased osmolality (p<0.05), but not with other laboratory values such as pH, bicabonate, glucose, anion gap and dehydration status(p>0.05). CONCLUSION: It is necessary to conduct early aggressive evaluation for early diagnosis and proper treatment of DKA, because DKA occurs in patients with prior history of type II diabetes and without prior diabetic history as well as patients with prior history of type I diabetes.
Acid-Base Equilibrium ; Dehydration ; Diagnosis ; Early Diagnosis ; Female ; Glucose ; Gyeongsangbuk-do ; Humans ; Hydrogen-Ion Concentration ; Male ; Medical Records ; Mortality ; Osmolar Concentration ; Precipitating Factors ; Retrospective Studies

No abstract available.
Cor Triatriatum*

BACKGROUND AND OBJECTIVE: AT-1 cells have been derived from the left atrial tissue in which the ANF promoter targeted SV40 large T antigen expression. When cultured, clusters of spontaneously contracting cells were observed after 4-5 days and contiguous sheets of synchronously beating cardiomyocytes were formed after 10 days. In this study, expression of several cell cycle regulatory genes were monitored through Northern blot analyses in AT-1 cells during beating and after formation of beating sheets (BS). MATERIALS AND METHOD: AT-1 RNAs were obtained in 3 days after plating, during beating and after formation of BS, and used for Northern blot analyses. RESULTS: alpha-Cardiac myosin heavy chain expression was prominent in beating cells, as would be expected for this contractile protein isoform but ANF was decreased after beating. Gax was not expressed in cultured AT-1 cells but in AT-1 tumor and murine heart. p53 and p21 were decreased after beating which indicate transcription level of p53 and p21 correlated well in AT-1 cells. In contrast, pRB and p107 were increased after beating but p68 (2.4 kb) which arose by alternative splicing of p107 and lacks the pocket domain B was decreased in beating cells. pTCS2, murine tuberous sclerosis gene, represented similar levels during beating but a little was decreased after formation of BS. mRAD50, the murine homologue of yeast DNA recombinational repair gene RAD50, was increased in beating cells, a similar pattern to p107 and pRB. But the p50 arose by alternative splicing of mRAD50 and has 3' half of mRAD50 had unexpectedly appeared and maintained after beating. CONCLUSION: The expression of cell cycle regulatory genes after beating and formation of BS in AT-1 cells showed gene-specific pattern and the p50 which has homology to the mRAD50 may participate in differentiation of cardiomyocytes.
Alternative Splicing ; Antigens, Viral, Tumor ; Atrial Natriuretic Factor ; Blotting, Northern ; Cell Cycle* ; Genes, Regulator* ; Heart ; Myocytes, Cardiac* ; Myosin Heavy Chains ; Recombinational DNA Repair ; RNA ; Tuberous Sclerosis ; Yeasts

BACKGROUND: To examine whether nonemergency patients can be identified and be safely triaged out of the emergency department. METHODS: Adult patients(16 years or older) who visited to the emergency department were prospectively studied from July 1 to August 31, 1997. Authors developed a new triage composed of vital signs, mental status, chief complaints, etiology, and a mode of transfer. Chi-square test and a discriminant analysis were applied for statistical analysis. RESULTS: In a discriminant analysis, mode of transfer, chief complaint, age, heart rate, mental status, etiology, and body temperature were significant variables in order. In a canonical discriminant value at group mean, a nonemergent value is 0.450 and a emergent value -0.219. CONCLUSIONS: In simply applicable triage method, mode of transfer and chief complaints are more important than vital sign and mental status. This method is useful in disaster situation and non-medical personnel may use this triage method easily. But some patients are not triaged by this triage method, thus more studies and discussions are necessary.
Adult ; Body Temperature ; Disasters ; Emergencies* ; Emergency Service, Hospital* ; Heart Rate ; Humans ; Prospective Studies ; Triage* ; Vital Signs

No abstract available.

No abstract available.
Child* ; Esophageal and Gastric Varices* ; Humans ; Hypertension, Portal* ; Portal Vein*

BACKGROUND: The goal of this study is to identify the factors that predict mortality in elderly trauma patients. METHOD: We reviewed retrospectively the medical record of 144 cases of geriatric trauma admitted to Kyungpook National University Hospital firm January 1998 to December 1998. We evaluated the general characteristics, mechanisms of injury, Revised Trauma Score(RTS), Injury Severity Score(ISS), Probability of survival(Ps) by TRISS(Trauma and Injury Severity Score) method, amount of blood transfused, preexisting disease, complications, length of stay, and mortality. RESULTS: 1. The mean age was 75.39+/-7.89 years old, and male to female ratio was 0.89 : 1. 2. The mechanisms of injury were primarily frills(56.3%) followed by bicycle or motorcycle(13.9%), and pedestrian injuries(13.2%) and motor vehicle accidents(6.9%). 3. The mean Glasgow Coma Scale(GCS), RTS and ISS ate 13.3+/-3.5, 7.2+/-1.4 and 14.2 +/-11.6 respectively. 4. The actual mortality rate was 18.1% (26/144). But by TRISS method, predicted mortality rate was 9.3%(12.5/144), excess mortality rate was 108% and Z score was 3.99 indicating that actual number of death exceed predicted number of death. 5. Between the survivors and nonsurvivors, the insults were significantly different as follows ; systolic blood pressure(141.9+/-28.3 vs. 116.8+/-48.7 mmHg), GCS(14.3+/-2.0 vs. 9.0 +/-5.1), RTS(7.8+/-0.7 vs 5.4+/-2.3), ISS(11.3+/-5.6 vs 27.2+/-20.2), Ps by TRISS(0.97+/-0.06 vs 0.65+/-0.37), preexisting diseases(50.8 vs 69.8%). CONCLUSION: Geriatric patients are more likely to die after trauma than other age groups. The cause of higher actual mortality rate compared to predicted mortality rate was considered as the higher incidence of delayed death due to sepsis or multiple organ failure. In order to reduce the mortality, even with relatively stable initial vile sign, invasive hemodynamic monitoring and intensive treatment are recommended and also, prevention and treatment of nosocomial infection are very important.
Aged ; Coma ; Cross Infection ; Female ; Gyeongsangbuk-do ; Hemodynamics ; Humans ; Incidence ; Length of Stay ; Male ; Medical Records ; Mortality* ; Motor Vehicles ; Multiple Organ Failure ; Preexisting Condition Coverage ; Retrospective Studies ; Sepsis ; Survivors

Spontaneous pneumothorax is an accumulation of air in the pleural space with collapse of the lungs in the absence of external chest trauma. In this study, 175 cases of spontaneous pneumothorax experienced at emergency room of Kyungpook University Hospital from July 1995 to June 1996 were analyzed retrospectively. The results were summarized follows: 1. Sex ratio of male to female was 6.6:1 and the mean age was 36.7 years. 2. In clinical symptoms, dyspnea was 85 cases(48.6%), chest pain 67 cases(38.3%), chest discomfort 18 cases(10.3%), coughing 2 cases(1.1%), and others 3 cases(1.7%). 3. In etiology of spontaneous pneumothorax, primary spontaneous pneumothorax was 118 cases(67.4%) and secondary spontaneous pneumothorax 57 cases(33.6%). The underlying pathologic lesion of secondary spontaneous pneumothorax showed pulmonary tuberculosis in 50 cases(28.6%), COPD in 5 cases(2.9%), bronchial asthma in 1 case(0.6%), and pneumoconiosis in 1 case(0.6%). 4. The incidence of recurrence was as follows; no previous history in 123 cases(70.3%), second attack in 35 cases(20.0%), third attack in 15 cases(8.6%), fourth attack in 1 case(0.6%), and fifth attack in 1 case(0.6%). 5. The interval of recurrence after last attack was as follows; less than 6 months in 36 cases(69.2%), between 6 months and 1 year in 5 cases(9.6%), between 1 and 2 years in 3 cases(5.8%), between 2 and 3 years in 2 cases(3.8%), and greater than 3 years in 6 cases(11.5%). 6. In distribution of the lesion sites, left was 93 cases(53.1%), right 80 cases(45.7%), and bilateral 2 cases(1.1%). 7. In degree of lung collapse, 17 cases(9.7%) were small(<20%), 127 cases(72.6%) moderate(20-40%), and 31 cases(17.7%) large(>40%). 8. The accompanied diseases of spontaneous pneumothorax were found in 17 cases, in which hydrothorax were 14 cases and hemothorax were 3 cases. 9. The employed management were as follows; bed rest with oxygen inhalation in 6 cases(3.4%), thoracentesis in 4 cases(2.3%), closed thoracostomy in 136 cases(77.7%), and open thoracotomy in 29 cases(16.6%). 10. The reexpansion time after chest tube insertion was as follows; less than 1 day in 147 cases (89.6%), between 1 and 2 days in 12 cases(7.3%), between 2 days and 1 week in 4 cases(2.4%), and greater than 1 week in 1 case(0.6%). 11. The duration of chest tube insertion was as follows; less than 1 week in 102 cases(62.2%), between 1 and 2 weeks in 34 cases(20.7%), between 2 and 3 weeks in 14 cases(8.5%), between 3 and 4 weeks in 7 cases(4.3%), and greater than 4 weeks in 7 cases(4.3%). 12. The complications of closed thoracostomy were as follows; incomplete lung expansion in 4 cases and empyema in 1 case. 13. The indications of open thoracotomy were as follows; bleb or bullae on chest X-ray in 12 cases (41.4%), persistent air leak in 8 cases(27.6%), recurrent pneumothorax in 4 cases(13.8%), incomplete lung expansion in 3 cases(10.3%), and contralateral pneumothorax history in 2 cases(6.9%). 14. The duration of hospitalization was as follows; less than 1 week in 100 cases(57.1%), between 1 and 2 weeks in 29 cases(16.6%), between 2 and 3 weeks in 22 cases(12.6%), between 3 and 4 weeks in 9 cases(5.1%), and greater than 4 weeks in 15 cases(8.6%).
Asthma ; Bed Rest ; Blister ; Chest Pain ; Chest Tubes ; Cough ; Dyspnea ; Emergency Service, Hospital ; Empyema ; Female ; Gyeongsangbuk-do ; Hemothorax ; Hospitalization ; Humans ; Hydrothorax ; Incidence ; Inhalation ; Lung ; Male ; Oxygen ; Pneumoconiosis ; Pneumothorax* ; Pulmonary Atelectasis ; Pulmonary Disease, Chronic Obstructive ; Recurrence ; Retrospective Studies ; Sex Ratio ; Thoracostomy ; Thoracotomy ; Thorax ; Tuberculosis, Pulmonary

PURPOSE: Laparoscopic splenectomy (LS) is one method for treatment of various diseases of the spleen, especially hematological conditions. However, few recent long-term follow-up results have been reported. The purpose of this study is to evaluate the outcome of patients in a single institution who recently underwent LS and to analyze their long-term follow-up results. METHODS: Of 366 splenectomies, this study was conducted as a retrospective review of 52 patients who underwent LS for treatm ent of hematological or primary diseases of the spleen from January 1998 to October 2011. The data included age, sex, pathological diagnosis, operative time, postoperative hospital stay, rate to open conversion, perioperative transfusion, morbidity, mortality, and relapse. We analyzed outcomes of variable results through long-term follow-up. RESULTS: The mean follow-up period was 84 months (range, 4~147 months). The most common indication for LS was immune thrombocytopenic purpura (ITP). The median postoperative hospital stay was eight days (range, 3~28 days). Mean operative time was 203 minutes (range, 115~475 minutes). Two patients underwent open conversion. Thirty eight patients received perioperative transfusions. The mean spleen weight was 294.9 g (range, 31~2,564 g). The overall morbidity rate was 5.8% and one patient experienced relapse. Of the 28 patients with ITP, 89.3% responded to LS. CONCLUSION: LS should be one of the best treatment options regardless of splenomegaly and spleen-associated diseases. In particular, for patients with ITP, LS has shown very effective long-term follow-up results. Therefore, LS should be more actively considered as an early treatment option in surgical disease of the spleen, such as ITP.
Diagnosis ; Follow-Up Studies ; Hematologic Diseases ; Humans ; Length of Stay ; Methods ; Mortality ; Operative Time ; Purpura, Thrombocytopenic, Idiopathic ; Recurrence ; Retrospective Studies ; Spleen* ; Splenectomy* ; Splenomegaly

The purpose of this study was to investigate a plan of middle/high school foodservice systems which could properly provide nutrition for juveniles' health. Questionnaires were developed and distributed to: 245 middle schools with 271 parentis, 328 students, 180 teachers, and 345 administrators; 163 high-schools with 223 parents, 466 students, 179 teachers, and 163 administrators in Seoul and Kyunggi province. The results of this study were as followed. For the desirable feeding type as in-school meal plan, 62.2% responded to the current elementary school feeing type;10.3% responded to a lunch-box prepared at home; and 38.0% responded to free dining out type. For a feeding operation type, school administrators, teachers and parents favored the current school feeding systems in elementary schools with proportion of 68.2%, 47.7%, and 87.6% as respectively. Also, 20.3% of school administrators, 22.6% of teachers, and 6.9% of parents preferred contract management. A total of 27.6% of teachers, 9.2% of school administrators, and 3.7% of parents responded to a lunch-box prepared at home. There was a significant difference between the responses for establishing the main body of financial burden to solve the problem of financial burden which could be the most obstacle to bring middle/high school feeding system into operation. For the management of school feeding systems when brought into operation, 88.7% out of 470 responded schools and 89.9% out of 227 responded teachers reported that an expert should manage school feeding systems. For futuristic direction, an effective joint cooking type between schools which may be the way to solve the difficulties in securing the appropriate space and to decrease the financial burden, the problem of transportation for delivering feeding products, low quality of feeding, and sanitation can occur. Therefore, the distance between schools which operate a joint cooking system will affect as a major factor. Furthermore, concrete examination of plans for introduction of various types of school feeding and institutional devices for management system and supervision of operation should become a condition precedent.
Administrative Personnel ; Cooking ; Fees and Charges ; Gyeonggi-do* ; Humans ; Joints ; Meals ; Organization and Administration ; Parents ; Surveys and Questionnaires ; Sanitation ; Seoul* ; Transportation