BACKGROUND: Recent advances have been made in the treatment of acute stroke, but the effectiveness of the new therapies is highly time-dependent. The purpose of this study is to investigate the factors that influence the time from symptom onset to hospital arrival and the total arrival delay time for patients with acute stroke. METHODS: A prospective registry of patients presenting to the ED with signs or symptoms of acute stroke was established at Ewha Womans University Mokdong and Dongdaeumn hospitals from March to December 1999. We analyzed the prehospital delay time(reaction interval and total arrival delay) and factors associated with delayed arrival at the hospital. RESULTS: The study included 256 patients(49% were women) with a mean age of 62+/-13 years. 50.9% of the patients arrived within 3 hours, and 94.9% patients arrived within 24 hours after onset of symptoms of acute stroke. The total arrival delay time was 180 minutes(median time), and the reaction interval was 60 minutes(median time). Transportation by 119 or 129 ambulances was linked to shorter delay(47 minutes). Age, mental status, and degree of disability were statistically significant factors associated with delayed arrival at the hospital. CONCLUSION: Age, mental status, and degree of disability were significant factors associated with delayed arrival at the hospital. For effective treatment of acute stroke patients, increased public awareness to use an ambulance with direct transport to the acute-care hospital required.
Ambulances ; Female ; Humans ; Prospective Studies ; Stroke* ; Transportation

PURPOSE: Effective chest compressions may improve the return of spontaneous circulation and positive neurologic outcomes in cardiac arrest victims. Out of concern for rescuer fatigue, guidelines for cardiopulmonary resuscitation (CPR) recommend that the individual applying chest compressions should be switched every 2 minutes, but there is little evidence to support this recommendation. In this study, we investigated whether or not changing the individual who is applying chest compressions every 2 minutes during cardiopulmonary resuscitation is appropriate or not. METHODS: We recruited health personnel working at one university hospital on a volunteer basis. On a randomly assigned day, we compared the effectiveness of the use of multiple rescuers following the 2 minute guideline, versus single rescuer (rescuer-limited) in performance of CPR. The resulting data was collected by use of CPR recording technology, and chest compression quality variables including compression rate, compression depth, proportion of adequate compression depth, and proportion of incomplete recoil were recorded. RESULTS: There were statistically significant improvements in the rescuer-limited trial outcome including average compression depth (p=0.013), proportion of adequate compression depth (p=0.027), and difference in reported fatigue (0.007). CONCLUSION: In this study, we found that a rescuer-limited method is more effective than the multiple rescuer method in terms of subjective fatigue and chest compression quality metrics.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Heart Arrest ; Humans ; Thorax

PURPOSE: A eutectic mixture of local anesthetics (EMLA(R)) cream has been used as a topical anesthetic to reduce the pain of procedures penetrating the skin. It is generally applied for 40 to 60 minutes before the painful procedure. Because of the long application period, EMLA(R) is not useful in the emergency department (ED). The purpose of this study was to determine whether a 20-minute application of 9.6% lidocaine would be useful in reducing the pain of routine peripheral intravenous cannulation in the ED. METHODS: We examined 27 male and 19 female patients ages over 18 years of age who required intravenous cannula insertion. Intravenous insertion was performed on 46 patients: 24 patients in the placebo group (mean age: 40.0 years) and 22 in the 9.6% lidocaine group (mean age: 37.6 years). The 9.6% lidocaine or placebo gel was applied and covered with an occlusive dressing for 20 minutes. Pain was scored by the patients using a 0- to 10-cm visual analogue scale. RESULTS: The patients in the 9.6% lidocaine group (mean pain score: 3.4) experienced less pain than those in the placebo group (mean: 5.3), and the difference was statistically significant (p=0.029). CONCLUSION: We concluded that a 20-minute application of 9.6% lidocaine is safe and effective for reducing pain associated with venipuncture.
Anesthesia, Local* ; Anesthetics, Local ; Catheterization ; Catheters ; Emergency Service, Hospital ; Female ; Humans ; Lidocaine* ; Male ; Occlusive Dressings ; Phlebotomy* ; Skin

BACKGROUND: The objective of this study was to determine the sensitivity, specificity of the ultrasound examination performed by emergency physicians in patients with altered mental state due to trauma. METHODS: From July 1998 until June 2000, a total number of 59 patients showing altered mental state were examined using emergency ultrasound at the time of primary survey. Their medical records were reviewed, and the interpretations of the emergency ultrasound were compared with the abdominal CT scan or clinical results. RESULTS: Of the 59 patients, 3 were excluded due to incomplete records. Among the 56 remaining patients, 9 patients had intra-abdominal problems. The sensitivity and specificity were 77% and 95.7%, respectively. Abdominal CT was not required in 41 (73.2%) patients. CONCLUSION: Emergency ultrasonography can serve as a useful screening tool in detecting free fluid in trauma victims who are not mentally alert.
Emergencies* ; Humans ; Mass Screening ; Medical Records ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Ultrasonography*

PURPOSE: In order to elicit efficient and effective operation of the Korean Emergency Medical Service System, we observed patients brought in by way of the Emergency Center by 119 ambulances and analyzed the appropriateness of the transport and the level of emergency care provided. METHODS: For the month of August 2002, patients who visited a university hospital emergency unit in Seoul were separated and evaluated according to the study protocols. The appropriateness of the 119 transport was based on a patient questionnaire and an evaluation of medical records and was categorized as follows; 1) need for emergency care or urgency/emergency transport by 119 ambulance, 2) need for emergency care or urgency/emergency transport by non 119 ambulance, 3) no need for emergency care or subemergency/nonemergency transport by 119 ambulance, 4) no needs for emergency care or subemergency/ nonemergency transport by non 119 ambulance. Of these, category 1 is viewed as the appropriate level of transport to the hospital emergency unit by 119 rescuers whereas category 3 is considered inappropriate transportation by 119 rescuers. The analysis of the appropriateness of the level of emergency care was based on sorting patients into 5 service categories; 1) emergency care required - appropriate operation, 2) emergency care required - no operation, 3)emergency care required - inappropriate operation, 4) no emergency care required - operation, 5) no emergency care required - no operation. Within these, categories 1 and 5 are considered appropriate and categories 2, 3 and 4 as inappropriate. RESULTS: Over the course of the study, 1,376 out of 1,451 patients transported to the hospital emergency unit qualified to be included under study protocols. Among them, the proportion of patients who needed emergency care or urgency/emergency transport was 22.8% (314 patients), and the proportion of those who received appropriate transport by the 119 emergency team was 62.6% (196 patients). Among the 282 patients who were transported by 119 emergency teams, in 195 patients (69.1%), emergency care was indicated while only 81 of the 195 patients (41.5%) received operations with an emergency or critical level of care. Of these 81, 47 patients (58.0%) received the appropriate operation. Therefore, the overall appropriateness of emergency care was 45.0% (127 patients), including emergency care required - appropriate operation (47 patients) and no emergency care required - no operation (80 patients). CONCLUSION: From this study, the appropriateness of transport by 119 rescuers is 62.6% but if subemergency cases are included, the appropriateness of transport increases to 95.2%. However, the appropriateness of care is only 45.0%, implying a need for continuing training for 119 emergency medical technicians and further organization of the medical control system.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Emergency Service, Hospital ; Humans ; Medical Records ; Surveys and Questionnaires ; Seoul ; Transportation

Anemia is a common and significant complication of chronic kidney disease (CKD). However, its prevalence and current management status has not been studied thoroughly in Korea. We examined the prevalence of anemia, its association with clinical and laboratory factors, and utilization of iron agents and erythropoiesis stimulating agents using the baseline data from the large-scale CKD cohort in Korea. We defined anemia when hemoglobin level was lower than 13.0 g/dL in males and 12.0 g/dL in females, or received by erythropoiesis stimulating agents. Overall prevalence of anemia was 45.0% among 2,198 non-dialysis CKD patients from stage 1 to 5. Diabetic nephropathy (DN) as a cause, CKD stages, body mass index (BMI), smoking, leukocyte count, serum albumin, iron markers, calcium, and phosphorus concentration were identified as independent risk factors for anemia. Considering the current coverage of Korean National Health Insurance System, only 7.9% among applicable patients were managed by intravenous iron agents, and 42.7% were managed by erythropoiesis stimulating agents.
Anemia* ; Body Mass Index ; Calcium ; Cohort Studies* ; Diabetic Nephropathies ; Female ; Hematinics ; Humans ; Iron ; Korea ; Leukocyte Count ; Male ; National Health Programs ; Phosphorus ; Prevalence* ; Renal Insufficiency, Chronic* ; Risk Factors ; Serum Albumin ; Smoke ; Smoking

In allogeneic transplantation, including the B6 anti-BALB.B settings, H60 and H4 are two representative dominant minor histocompatibility antigens that induce strong CD8 T-cell responses. With different distribution patterns, H60 expression is restricted to hematopoietic cells, whereas H4 is ubiquitously expressed. H60-specific CD8 T-cell response has been known to be dominant in most cases of B6 anti-BALB.B allo-responses, except in the case of skin transplantation. To understand the mechanism underlying the subdominance of H60 during allogeneic skin transplantation, we investigated the dynamics of the H60-specific CD8 T cells in B6 mice transplanted with allogeneic BALB.B tail skin. Unexpectedly, longitudinal bioluminescence imaging and flow cytometric analyses revealed that H60-specific CD8 T cells were not always subdominant to H4-specific cells but instead showed a brief dominance before the H4 response became predominant. H60-specific CD8 T cells could expand in the draining lymph node and migrate to the BALB.B allografts, indicating their active participation in the anti-BALB.B allo-response. Enhancing the frequencies of H60-reactive CD8 T cells prior to skin transplantation reversed the immune hierarchy between H60 and H4. Additionally, H60 became predominant when antigen presentation was limited to the direct pathway. However, when antigen presentation was restricted to the indirect pathway, the expansion of H60-specific CD8 T cells was limited, whereas H4-specific CD8 T cells expanded significantly, suggesting that the temporary immunodominance and eventual subdominance of H60 could be due to their reliance on the direct antigen presentation pathway. These results enhance our understanding of the immunodominance phenomenon following allogeneic tissue transplantation.
Animals ; Antigen Presentation ; Antigen-Presenting Cells/immunology/metabolism ; CD8-Positive T-Lymphocytes/*immunology ; Epitopes, T-Lymphocyte/*immunology ; Female ; Graft Rejection/*immunology ; Interferon-gamma ; Lymphocyte Activation/immunology ; Lymphocyte Count ; Mice ; Minor Histocompatibility Antigens/*immunology/metabolism ; *Skin Transplantation ; Transplantation, Homologous

Background: Data on the relationship between Parkinson's disease (PD) and stroke have been conflicting, some studies showing a reduced risk of stroke during life because of low prevalence of vascular risk factors, and others indicating an increased risk of strokerelated death. The objective of this study is to determine the frequency of vascular risk factors in PD in relation to an unaffected control group and ischemic stroke patient group. Methods: We performed a case-control study on 206 consecutive PD patients, 207 ischemic strokes patients (served as "Disease" controls) and 138 age and sex matched normal subjects (served as controls), calculating multivariate risk estimates (odd ratio) for a series of established risk factors for vascular disease. Results: We found that (1) cigarette smoking (smoker, 0.078, CI=0.034-0.178; ex-smoker, 0.031, CI=0.011-0.088), and diabetes mellitus (0.340, CI=0.169-0.682) were significant less frequent in PD patients than controls, (2) cigarette smoking (smoker, 0.230, CI= 0.094-0.561; ex-smoker, 0.132, CI=0.050-0.348), hypertension (0.283, CI=0.175-0.459), diabetes mellitus (0.257, CI=0.136-0.486), previous stroke (0.063, CI=0.020-0.191), heart disease (0.344, CI=0.176-0.673) than ischemic stroke patients, respectively. Conclusion: We found the significant negative association of a series of vascular factors with PD, indicating a protective effect of PD against ischemic stroke.
Case-Control Studies ; Diabetes Mellitus ; Heart Diseases ; Humans ; Hypertension ; Parkinson Disease* ; Prevalence* ; Risk Factors* ; Smoking ; Stroke ; Vascular Diseases*

Central nervous system toxicity is the most commonly recognized problem during treatment with carbamazepine (CBZ). The most common side effects of CBZ are drowsiness, incoordination, and vertigo. However, unusual conditions such as movement disorders, seizure aggravation, and encephalopathy have also been attributed to CBZ therapy. In case 1, cognitive dysfunction and exacerbation of preexisting gait disturbance were observed in a 63-year-old female who had frontal lobe epilepsy, schizencephaly, and lissencephaly treated with CBZ. The neurological symptoms were resolved 24 hours after the withdrawal of CBZ and induced with the reintroduction of CBZ. In case 2, myoclonic jerks occurred in a 37-year-old female when CBZ was readministered after a 4-day-withdrawal period of CBZ. The myoclonic jerks disappeared 12 days after CBZ was discontinued. In both cases, plasma CBZ levels were within the therapeutic range. We report two cases with encephalopathy and myoclonic jerks as unusual side effects of CBZ, with the plasma levels of CBZ being within the therapeutic range.
Adult ; Ataxia ; Carbamazepine ; Central Nervous System ; Epilepsy, Frontal Lobe ; Female ; Gait ; Humans ; Lissencephaly ; Malformations of Cortical Development ; Middle Aged ; Movement Disorders ; Myoclonus* ; Plasma ; Seizures ; Sleep Stages ; Vertigo

Background: Total knee arthroplasty (TKA) is a procedure that has a risk of perioperative blood loss and allogeneic blood transfusion. The purpose of the present study was to compare the perioperative blood loss and transfusion rate between the 3-hour interval clamping and 12-hour interval clamping of closed suction drainage after simultaneous bilateral total knee arthroplasty (SBTKA). Methods: A total of 122 SBTKAs were enrolled in this retrospective study. A 3-hour clamping protocol was applied in 53 SBTKAs and a 12-hour clamping protocol was applied in 69 SBTKAs. The amount of perioperative blood loss, transfusion requirements, postoperative hemoglobin and hematocrit levels, the lowest hemoglobin and hematocrit levels during hospitalization, readmission within 90 days, and clinical outcomes were compared between the 3-hour clamping group and the 12-hour clamping group. Results: The 12-hour clamping group had fewer patients requiring transfusion (26.1%, 18/69) than did the 3-hour clamping protocol group (49.1%, 26/53) (p = 0.008). The 12-hour clamping group had a lower amount of estimated blood loss (1,426.9 ± 421.5 mL) than did the 3-hour clamping protocol group (1,882.1 ± 445.6 mL) (p < 0.001). The 12-hour clamping group showed higher hemoglobin and hematocrit levels (both p < 0.001) on postoperative day 5 than did the 3-hour clamping group. The lowest hemoglobin and hematocrit levels were higher in the 12-hour clamping group than in the 3-hour clamping group (p = 0.039 and p = 0.016, respectively). Within 1 postoperative month, there were 2 cases of wound dehiscence in each group (p = 0.585). But, at 1 year after the operation, no serious complications occurred in the two groups. Conclusions Compared to the 3-hour clamping protocol, the 12-hour clamping protocol significantly reduced transfusion requirements, estimated blood loss volume, and hemoglobin and hematocrit levels after SBTKA. We suggest that 12-hour temporary clamping should be considered for reducing transfusion rates.