BACKGROUND: Tsutsugamushi disease, Leptospirosis, and Hemorrhagic fever with renal syndrome(HFRS) are an acute febrile illness of autumn-winter type which are characterized by fever, headache, myalgia in acute stage. We reported the clinical and laboratory characteristics of 49 cases under investigation far febrile illness in rural communities of Korea in order to differentiate the diagnosis among Tsutsugamushi disease, Leptospirosis, and HFRS. METHODS: This study was done retrospectively by investigation of patient's age, occupation, symptom, laboratory findings and chest X-ray findings of Tsutsugamushi disease, Leptospirosis, and HFRS. All patients was seen in our hospital between September and November in 1997 and 1998 consecutive year. RESULTS: The most characteristic symptoms and signs of Tsutsugamushi disease were eschar(90.1%), and skin rash(70%). The epidemiological and laboratory characteristics of Tsutsugamushi disease were age 40 or more, farmer(90.1%), s-GOT(serum glutamic oxaloacetic transaminase) and s-GPT(serum glutamic pyruvic transaminase) elevation. The most characteristic symptoms and signs of Leptospirosis were sputum and cough(75%). The epidemiological and laboratory characteristics of Leptospirosis were all farmers(100%), hyperbilirubinemia(1.67 mg/dl). The most characteristic symptoms and signs of HFRS were gastrointestinal disturbance(100%), flank pain(66.7%). The epidemiological and laboratory characteristics of HFRS were leukocytosis, thrombocytopenia, azotemia, proteinuria (91.6%), and hematuria (83.3%). CONCLUSION: As the clinical feature, presence of eschar and skin rash were suggestive of Tsutsugamushi disease. As the clinical feature, presence of cough and sputum and laboratory finding such as elevation of bilirubin level were suggestive of Leptospirosis. As the clinical feature, presence of gastrointestinal disturbance, flank pain and laboratory finding of thrombocytopenia, and renal dysfunction were suggestive of HFRS.
Azotemia ; Bilirubin ; Cough ; Diagnosis ; Exanthema ; Fever ; Flank Pain ; Headache ; Hematuria ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Korea* ; Leptospirosis ; Leukocytosis ; Myalgia ; Occupations ; Proteinuria ; Retrospective Studies ; Rural Population* ; Scrub Typhus ; Skin ; Sputum ; Thorax ; Thrombocytopenia

Four hundred and fifty patients of cerebrovascular accident who underwent computerized tomographic scanning during the 45 months, from January 1978 to October 1981, at department of internal medicine, Kyung Hee University Hospital, were studied and following results were obtained. 1. In Korea, intracerebral hematoma(48.2%) is more common than cerebral infarction(27.6%). 2. 87.3% of intracerebral hemorrhage were comfirmed while 61.5% of cerebral infarction were identified by brain CT. 3. Cerebrovascular accidents are definitely developing in 6th decade(40.6%) and male is more often affected. 4. hypertension is the most common underlying disease(72.3%) of cerebral hemorrhage, 52.4% of cerebral infarction. 5. hematoma occurs most frequently in basal ganglia(40.6%) and cerebral infarction occurs most frequently in global area(48.4%). 6. Changes of consciousness level were observed in 54.2% of the cases of mild degree hematoma. Mortality was 6.2% in mild degree hematoma and 88.2% in severe degree hematoma. 7. In 26.2% of cerebral hematoma, inital CSF findings were normal in spite of the evidence of cerebral hematoma confirmed by CT scanning.
Brain* ; Cerebral Hemorrhage ; Cerebral Infarction ; Classification* ; Consciousness ; Hematoma ; Humans ; Hypertension ; Internal Medicine ; Korea ; Male ; Mortality ; Stroke* ; Tomography, X-Ray Computed

Follicular bronchiolitis is an uncommon bronchiolar disorder that is characterized by the presence of hyperplastic lymphoid follicles with reactive germinal centers. The condition is associated with connective tissue diseases such as rheumatoid arthritis, Sjögren’s syndrome, and immunodeficiency disorders. A 56-year-old man with rheumatoid arthritis was admitted to hospital with a progressively enlarging pulmonary nodule in the left upper lobe. A follow-up contrast tomography scan showed that the nodule had increased in size from 4.2 mm to 6.3 mm over a 3 month period. An open lung biopsy was performed to establish a definite pathologic diagnosis of the pulmonary nodule, which was suspected to be a lung malignancy. The nodule was diagnosed as follicular bronchiolitis based on the histopathology findings. We describe a patient with follicular bronchiolitis that was confirmed by an open lung biopsy, and is believed to have had rheumatoid involvement.
Arthritis, Rheumatoid* ; Biopsy ; Bronchiolitis* ; Connective Tissue Diseases ; Diagnosis ; Follow-Up Studies ; Germinal Center ; Humans ; Lung ; Middle Aged ; Solitary Pulmonary Nodule

Serum lipids and lipoproteins were determined in 70 patients with hypertension, 40 patients with cerebral infarctions, and 41 patients with cerebral hemorrhage. The results were compared with findings in 64 healthy controls. The results are as follows; 1) Total cholesterol, VLDL-cholesterol, LDL cholesterol and total cholesterol/HDL-cholesterol ratio were significantly higher in patients with hypertension or cerebral infarction than in control group, but HDL-cholesterol showed no significant difference. 2) In Patients with cerebral hemorrhage, total cholesterol, LDL-cholesterol and HDL-cholesterol were higher than in normal controls. Total cholesterol/HDL-cholesterol ratio was within the limits of normal. It is possible that the susceptibility to cerebral infarction is the result of high total cholesterol/HDL cholesterol ratio rather than low HDL cholesterol. But our study suggests that hyperlipoproteinemia plays a minor role in the development of cerebral hemorrhage.
Cerebral Hemorrhage ; Cerebral Infarction ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Humans ; Hyperlipoproteinemias ; Hypertension* ; Lipoproteins

PURPOSE: Upper gastrointestinal bleeding (UGIB) is an urgent medical condition that emergency medicine doctors commonly encounter in the emergency room (ER). Initial management and triage of UGIB patients depend on nonendoscopic findings, so we sought risk factors for UGIB patients by using only the initial clinical data and the patient's condition in the ER. METHODS: By reviewing the data of 302 patients with the impression of UGIB between January of 1998 and December of 2000, the authors attempted to predict risk factors related to rebleeding, mortality, and need for surgical treatment. Based on blood analysis, physical exam, and history taking performed at the ER, the authors conducted a retrospective study in order to determine factors which influence rebleeding and overall mortality. RESULTS: From the blood pressure, pulse rate, and blood analysis taken at the time of admission, the levels of hemoglobin and hematocrits were shown to be related to rebleeding (p<0.05). If there was on-going bleeding, the relative risk of rebleeding was 2.314 times (p=0.023), and if the hemoglobin value was under 8 gm/dL, relative risk of rebleeding was 6.809 times (p=0.000). The factors which influenced the overall mortality rate were the blood pressure measured at the time of admission (p=0.001), the presence of on-going bleeding and rebleeding (p=0.000), and the level of hemoglobin, hematocrits and creatinine (p=0.001). A logistic regression analysis showed that when there was on-going bleeding, the relative risk of the mortality was 10.4 times (p=0.000) and when there was a high creatinine level, it was 7.8 times (p=0.001) CONCLUSION: When a patient with UGIB reports to the ER and shows unstable vital signs, a low hemoglobin level, and evidence of on-going bleeding, one should perform gastroendoscopy as soon as possible, and a need exists for aggressive treatment, even after admission.
Blood Pressure ; Creatinine ; Emergency Medicine ; Emergency Service, Hospital ; Heart Rate ; Hematocrit ; Hemorrhage* ; Humans ; Logistic Models ; Mortality* ; Retrospective Studies ; Risk Assessment* ; Risk Factors ; Triage ; Vital Signs

We had experienced a successful caudal anesthesia for the intramedullary nailing of fractured femur shaft in a 39 years-old, male, adult weighing 47 kg with severe kyphoscoliosis. We had chosen caudal anesthesia as an anesthetic method because of his poor pulmonary function and severe deformity of thoracolumbar spine. Caudal anesthesia was performed with administration of the mixture of 6 mL of 2% lidocaine, 12 mL of 1.5% lidocaine, 10 mL of 0.5% bupivacaine, and 0.15 mg of 0.1% epinephrine. We could achieve the adequate anesthetic sensory dermatome level, L1, for the operation without any significant deterioration of blood pressures and respiration. We recommend that caudal anesthesia is a useful anesthetic method for a patient with severe kyphoscoliosis when the operation on hip or lower extremity is required.
Adult ; Anesthesia, Caudal* ; Bupivacaine ; Congenital Abnormalities ; Epinephrine ; Femur* ; Fracture Fixation, Intramedullary ; Hip ; Humans ; Lidocaine ; Lower Extremity ; Male ; Respiration ; Spine

BACKGROUND: Pusan is geographically far away from the indigenous area of malaria. It is the area where the tourists and foreigners travel through frequently because of the port. We investigated the situation in Pusan concerning malaria through the examination of malaria patients who contracted it recently. We found the ways to decrease erroneous diagnosis presuming malaria on the basis of these studies. METHODS: We retrospectively analyzed the medical records of 28 confirmed cases of malaria with the chief complaint of repeated high fever, who were admitted and treated in the Pusan Adventist Hospital and Pusan Samsun Hospital from June 1997 to August 2000. RESULTS: 25 cases were indigenous and 3 patients were imported cases contracted overseas. Peripheral blood smears revealed Plasmodium vivax in all indigenous cases, whereas 2 were P. falciparum and 1 case was P. vivax in the imported cases. Yeonchon-goon(9 cases) was the most prevalent area in the indigenous cases. Africa and Southeast Asia(3 cases) were the contracted areas in the imported cases. 27 cases were men and 1 case was a woman among the 28 cases, and the incidence was high peak in 8-10 month. Most of the patients(72.1%) were in the their 20's, and most of all had worked in the military bases near the demilitarized zone(DMZ). Thrombocytopenia and leukopenia were found more frequently by the laboratory findings. 23 of the cases(82%) were suspected to be malaria, before we confirmed it by peripheral blood smears. CONCLUSION: The number of patients with indigenous malaria from the other areas in Korea and patients with malaria from foreign countries will be expected to increase. Before we confirmed the malaria by peripheral blood smears, the cases suspected of malaria were 82.1%. This is a high diagnostic rate due to careful history taking and physical examination. The doctors decreased the rate of erroneous diagnosis of malaria and should be careful in the choice of the proper drugs.
Africa ; Busan* ; Diagnosis ; Emigrants and Immigrants ; Female ; Fever ; Humans ; Incidence ; Korea ; Leukopenia ; Malaria* ; Male ; Medical Records ; Military Facilities ; Physical Examination ; Plasmodium vivax ; Retrospective Studies ; Thrombocytopenia

PURPOSE: Attention has been focused recently on the impact of sleep deprivation, in-house staff, and overwork on patient outcome. The objective of this study was to determine whether any associations existed between the timing of a patient visit to an emergency setting and hospital mortality. METHOD: We analyzed retrospectively a series of consecutive visits to the emergency room of our hospital in 2003. Patients were divided according to the times of their visits to emergency room daytime (from 8:00 am to 6:00 pm) and nighttime (all others). We further divided nighttime visits into early nighttime (from 6:00 pm to 1:00 am) and late nighttime (from 1:00 am to 8:00 am) visits. The odds of death within 48 hours after visit for patients in the nighttime group were analyzed by using a multivariate logistic regression. The independent variable was visit to the emergency room during nighttime. RESULT: The patients visiting at night had a lower mortality (0.9% vs 1.6%, p=0.000), with an odd ratio for death within 48 hours, adjusted for severity of illness, of 1.265 (95% CI, 0.955-1.674). Severity of illness was the main contributor to the increased mortality rates of patients in the nighttime group. There was no significant difference in mortality rates between the early and the late nighttime subgroups. CONCLUSION: Nighttime visits to the emergency room are not associated with a higher mortality than daytime visits.
Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality* ; Humans ; Korea* ; Logistic Models ; Mortality ; Night Care ; Retrospective Studies ; Sleep Deprivation

Complete interruption of the aortic arch is one of the least common cardic malformation. In this condition,continuity between the ascending and descending protions of the aorta is not present, and the descending aorta is supplied through a reversing patent ductus arteriosus. In the majority of the patients a ventricualr septal defectis present. Authors have expierenced a case of the complete intreruption of aortic arch, interruption between theleft caroitd and the left subclavian artery.
Aorta ; Aorta, Thoracic ; Ductus Arteriosus, Patent ; Humans ; Subclavian Artery

No abstract available.
Humans ; Prevalence* ; Renal Dialysis*