In modem medical industries as in others, it has been emphasized by many experts such as Dr. Mayer and Dr. Donabedean that there should be quality assurance activities applying statistical knowledges in the processes of medical management and medical staff themselves for the better medical care and customer satisfaction. Three of our quality assurance programs for the purpose of shortening the treatment time In the department of emergency medicine in Keimyung University, Dong-San Medical Center had been carried out during the period of June 94 through December 95. Our methodology was mainly the process emphasized ; finding the causes of delaying factors in various processes related to the works of nurses, doctors, laboratory services, radiology services etc. in the emergency room, holding various meetings among the related groups with genuine discussions, notifying the new results in each step, encouraging the positive ones and also applying the new leadership technics. During the period of June 94 through December 95(for 1.5 years), the average E.R. patient treatment time from registrations to dispositions had been reduced by about 2 hours (from 5 hours 3 minutes to 2 hours 5 minutes) and its variations among the different specialities had been narrowed down to significant degree (p<0.05) revealing the preprogram base line standard deviation of 2.43 to 1.28 in post program through continuous quality assurance programs. It was also noted that the successful results of Q/A program have been closely related to the fact that the process should be designed and redesigned repeatly as needed and that all the participants related were actively involved in the planning and redesigning processes.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leadership ; Medical Staff ; Modems

OBJECTIVE: As homeless people increased in urban areas after the economic crisis in Korea, they became a serious social problem. Foreign research showed that many homeless people had chronic mental illnesses which were closely related with the cause and prognosis of homelessness. But very little was known about the prevalence of mental disorders in Korean homeless people. This study tried to capture the overall picture of mental disorders in homeless people. METHOD: The study subjects were 216 homeless people who stayed at two Pusan shelters between late 1998 and early 1999. Questionnaires on sociodemographic data were administered to the subjects, and then diagnoses of major DSM-IV Axis I mental disorders were made using Structured Clinical Interview for DSM-IV Axis I Disorders(SCID). The lifetime and current prevalence of mental disorders in this study were compared to those from other studies in Korean general population and in foreign homeless people. RESULTS: The lifetime prevalence of major DSM-IV mental disorders(mood disorders, psychotic disorders, and substance use disorders) of 216 homeless people was 60.1%, and current prevalence was 35.7%. The lifetime prevalence of major depressive disorders was 22.5% which was higher than that of foreign studies. The lifetime prevalence of alcohol use disorder was 47.4%. The lifetime prevalence of psychotic disorders was 3.8%, and among them the lifetime prevalence of schizophrenia was 1.9% which was lower than that of foreign studies. CONCLUSIONS: In Korean homeless people, mood disorders and substance use disorders were the main mental disorders and psychotic disorders such as schizophrenia were less than in foreign homeless people. The plans to approach and treat homeless people with mental disorders should be made.
Axis, Cervical Vertebra ; Busan ; Depressive Disorder, Major ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Epidemiologic Studies* ; Homeless Persons ; Humans ; Korea ; Mental Disorders* ; Mood Disorders ; Prevalence ; Prognosis ; Psychotic Disorders ; Surveys and Questionnaires ; Schizophrenia ; Social Problems ; Substance-Related Disorders

BACKGROUNDS/AIMS: Intrahepatic recurrence is one of the most important causes of compromised prognosis after surgical resection of hepatocellular carcinoma (HCC). This retrospective study was designed to identify and compare the risks of recurrence, early recurrence and multiple recurrences in a single patient population. METHODS: A series of 92 consecutive patients, who received resection for single nodular HCC at our institute from January 2007 to December 2013, were enrolled in this study. The patients were divided into recurrent and non-recurrent groups; the recurrent group was further divided into subgroups by applying two criteria: early and late recurrence (with a cutoff of 18 months), and single and multiple (> or =2) recurrence. The potential risk factors were compared using univariate and multivariate analyses. The subgroup analysis was performed to determine the effects of different cut-off values on the analysis. RESULTS: 41 recurrences (44.6%) occurred during a mean follow-up of 42.4 months. The Child-Pugh score, and the portal vein invasion were found to be independent risk factors of recurrence, but differentiation was the only independent risk factor of early recurrence. The serum alpha-fetoprotein, tumor size, tumor necrosis, and hemorrhage were found to be the risk factors of multiple recurrences according to the univariate analysis, but lacked significance according to the multivariate analysis. When the cutoffs for early and multiple recurrences were changed to < or =10 months and >3 nodules, respectively, different risk factors were identified. CONCLUSIONS: Our results implicated that different factors can predict the recurrence, timing, and multiplicity of an HCC recurrence. Further studies should be conducted to prove the complex relationships between tumor burden, invasiveness, and underlying liver cirrhosis for initial tumors, and the timing and multiplicity of recurrent HCC.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver Cirrhosis ; Multivariate Analysis ; Necrosis ; Portal Vein ; Prognosis ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Tumor Burden

Aplastic anemia in pregnancy is an extremely rare condition with high maternal morbidity and mortality rates. Prognosis is poorer when aplastic anemia is complicated during pregnancy and many such patients have an unsuccessful pregnancy outcome. The relationship between aplastic anemia and pregnancy remains uncertain. Intensive hematological support remains the mainstay of therapy and a successful obstetric outcome can be best accomplished with the close clinical collaboration of the hematologist and the obstetrician. We report here a case of a 24-year-old woman with aplastic anemia, she experienced two consecutive vaginal deliveries. We present it with brief review of literature.
Anemia, Aplastic* ; Cooperative Behavior ; Female ; Humans ; Mortality ; Pancytopenia ; Pregnancy Outcome ; Pregnancy* ; Prognosis ; Young Adult

No abstract available.
Necrosis* ; Purpura, Schoenlein-Henoch*

BACKGROUND: Immune tolerance is regarded as the goal of the organ transplantation (TPLx), but the mechanism of tolerance induction remains to be established. Microchimerism (MC) development in long-surviving recipients after solid organ TPLx might be linked to tolerance. OBJECTIVE: We investigated the development and clinical relevance of donor specific MC in living related renal transplants with good graft function more than 3 years after TPLx. The relationship between MC and mixed lymphocyte reaction (MLR) hyporeactivity was also evaluated. MATERIALS AND METHODS: Eighteen recipients were included in this study among recipients whose renal function were stable for more than 3 years and have at least one mismatch of HLA DR loci. Donor-specific MC was examined with nested PCR method using HLA DRB1 gene probe in DNA extracted from peripheral blood and forearm skin tissue samples. Mean age at TPLx was 28.9 yrs (range: 13~42 yrs) and mean follow-up period was 67.4 months (range: 36~173 mos). Male to female ratio was 11:7. Acute rejection occurred in 4 and were reversed with steroid pulse therapy. All donors were alive (parent:8, sibling:9, offspring:1). Immunosuppression regimens were CSA(+)PDS in 11, AZA PDS in 1, AZA CSA(+)PDS in 5, and CSA monotherapy in 1. Mean serum BUN/Cr at the point of this study were 22.2+/-6.7 / 1.54+/-0.81 (mg/dL). The sensitivity of nested PCR using HLA DRB1 probe was 1/105~1/106. RESULTS: Donor-specific MC was detected in 6 (33.3%) (5 in blood, 5 in skin tissue). Nested PCR method was more sensitive than single round SSP-PCR method which showed only 2 positive recipients (11.1%). Two of four acute rejection experienced recipients were MC positive. Recipients were divided into two groups according to the follow-up period of 5 years. Two groups showed equal number of MC positivity. MLR was decreased in a group of more than 5 yrs follow-up. However, there was no difference in the decrement of MLR between MC positive and negative groups. CONCLUSION: MC was detected in 33.3% patients with nested PCR method. Since the MC positivity and MLR hyporesponsiveness shows no relationship, the significance of MC relevant to tolerance is to be determined through further study.
Chimerism* ; DNA ; Female ; Follow-Up Studies ; Forearm ; HLA-DRB1 Chains ; Humans ; Immune Tolerance ; Immunosuppression ; Kidney Transplantation ; Lymphocyte Culture Test, Mixed ; Male ; Organ Transplantation ; Polymerase Chain Reaction ; Skin ; Tissue Donors ; Transplants

BACKGROUND: Immune tolerance is regarded as the goal of the organ transplantation (TPLx), but the mechanism of tolerance induction remains to be established. Microchimerism (MC) development in long-surviving recipients after solid organ TPLx might be linked to tolerance. OBJECTIVE: We investigated the development and clinical relevance of donor specific MC in living related renal transplants with good graft function more than 3 years after TPLx. The relationship between MC and mixed lymphocyte reaction (MLR) hyporeactivity was also evaluated. MATERIALS AND METHODS: Eighteen recipients were included in this study among recipients whose renal function were stable for more than 3 years and have at least one mismatch of HLA DR loci. Donor-specific MC was examined with nested PCR method using HLA DRB1 gene probe in DNA extracted from peripheral blood and forearm skin tissue samples. Mean age at TPLx was 28.9 yrs (range: 13~42 yrs) and mean follow-up period was 67.4 months (range: 36~173 mos). Male to female ratio was 11:7. Acute rejection occurred in 4 and were reversed with steroid pulse therapy. All donors were alive (parent:8, sibling:9, offspring:1). Immunosuppression regimens were CSA(+)PDS in 11, AZA PDS in 1, AZA CSA(+)PDS in 5, and CSA monotherapy in 1. Mean serum BUN/Cr at the point of this study were 22.2+/-6.7 / 1.54+/-0.81 (mg/dL). The sensitivity of nested PCR using HLA DRB1 probe was 1/105~1/106. RESULTS: Donor-specific MC was detected in 6 (33.3%) (5 in blood, 5 in skin tissue). Nested PCR method was more sensitive than single round SSP-PCR method which showed only 2 positive recipients (11.1%). Two of four acute rejection experienced recipients were MC positive. Recipients were divided into two groups according to the follow-up period of 5 years. Two groups showed equal number of MC positivity. MLR was decreased in a group of more than 5 yrs follow-up. However, there was no difference in the decrement of MLR between MC positive and negative groups. CONCLUSION: MC was detected in 33.3% patients with nested PCR method. Since the MC positivity and MLR hyporesponsiveness shows no relationship, the significance of MC relevant to tolerance is to be determined through further study.
Chimerism* ; DNA ; Female ; Follow-Up Studies ; Forearm ; HLA-DRB1 Chains ; Humans ; Immune Tolerance ; Immunosuppression ; Kidney Transplantation ; Lymphocyte Culture Test, Mixed ; Male ; Organ Transplantation ; Polymerase Chain Reaction ; Skin ; Tissue Donors ; Transplants

PURPOSE: It is important in asthmatic children to encourage ordinary physical activity. However physical activities in winter are limited excessively by their parents for fear of bronchospasm by cold air and exercise. Children's asthma camps help them to learn about asthma management, make new friends with other asthmatic children, have positive attitude about the disease and have a more active lifestyle. But there have been few asthma camps and appropriate asthma camp programs have not been developed in Korea. Our study was done to see how camp programs influenced on asthma patient by measuring of PEFR during camp programs and thereby to have the data be used for future development of asthma camp programs. METHODS: From January 19th to 22th 1998, we recruited for camp 17 asthmatic patients and 31 normal children who had no history of admission due to respiratory infection. The main camp programs consisted of skiing and sledding. PEFR was checked 5 times a day and we analyzed variation of PEFR in relation to daily activities, temperature, humidity of atmosphere. RESULTS: 1) The mean age was 8 years with a range of 5 years to 11 years with male predominance (male/female : 2.4/1) in asthma group and the mean age was 10 years with a range of 5 years to 16 years with female predominance (male/female: 1/2) in control group. 2) The mean PEFR (% predicted) was checked early morning, prior to breakfast, lunchtime, supper and at the end of the day's activities (before sleeping) were 90.43+/-24.15%, 93.48+/-19.42%, 98.99+/-25.89%, 96.77+/-21.23%, 100.9+/-20.86% in asthma group and 93.69+/-16.41%, 94.49+/-17.13%, 94.15+/-17.28%, 96.84+/-16.44%, 96.52+/-16.24% in control group. All values were within normal range and there was no significant change of the mean PEFR value in relation to daily activity. The values of PEFR were low at early morning. We have observed a significant difference of PEFR between early morning and before sleeping in asthma group (P<0.05). 3) In the asthma group, 2 cases had respiratory difficulty prior to lunchtime but symptoms were resolved after bronchodilator nebulization. CONCLUSION: We recommend ski or sledding to be safe as one of the programs for asthma camp but control of asthma attack is needed because lung function is decreased at night and appropriate warming up is needed before cold air sports.
Asthma ; Atmosphere ; Breakfast ; Bronchial Spasm ; Child ; Female ; Friends ; Humans ; Humidity ; Korea ; Life Style ; Lunch ; Lung ; Male ; Meals ; Motor Activity ; Parents ; Peak Expiratory Flow Rate ; Reference Values ; Skiing ; Snow Sports ; Sports

OBJECTIVES: The aim of this study was to evaluate the prognostic value of volume-based metabolic parameters measured by 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in patients with nasopharyngeal carcinoma (NPC). METHODS: Forty-four NPC patients who underwent 18F-FDG PET/CT for initial staging work-up before concurrent chemoradiotherapy (CCRT) were retrospectively evaluated. Maximum standardized uptake value (SUV), mean SUV, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors were measured. The prognostic significance and predictive performance of these parameters were assessed by Cox proportional hazards regression analysis and time-dependent receiver operating characteristics (ROC) curve analysis. RESULTS: Multivariate analysis showed that American Joint Committee on Cancer stage 7th edition (hazard ratio [HR], 1.525; 95% confidence interval [CI], 1.062 to 2.188; P=0.022), and TLG (HR, 7.799; 95% CI, 2.622 to 23.198; P< or =0.001) were independent predictive factors associated with decreased disease-free survival (DFS). Time-dependent ROC curve analysis indicated that TLG was a better predictor of DFS than MTV (P=0.008). CONCLUSION: The TLG of the primary tumor was a significant independent metabolic prognostic factor of DFS in patients with NPC treated with CCRT.
Chemoradiotherapy* ; Disease-Free Survival ; Electrons* ; Fluorodeoxyglucose F18 ; Glycolysis ; Humans ; Joints ; Multivariate Analysis ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Prognosis ; Retrospective Studies ; ROC Curve ; Tumor Burden

PURPOSE: Gastric cancer is one of the most prevalent cancers worldwide. 5-fluorouracil (5-FU) and cisplatin are the most commonly used drugs for the treatment of gastric cancer. However, a significant number of tumors often fail to respond to chemotherapy. MATERIALS AND METHODS: To better understand the molecular mechanisms underlying drug resistance in gastric cancer the gene expression in gastric cancer cells, which were either sensitive or resistant to 5-FU and cisplatin, were examined using cDNA microarray analysis. To confirm the differential gene expression, as determined using the microarray, semiquantitative RT-PCR was performed on a subset of differentially expressed cDNAs. RESULTS: 69 and 45 genes, which were either up-regulated (9 and 22 genes) or down-regulated (60 and 25 genes), were identified in 5-FU- and cisplatin-resistant cells, respectively. Several genes, such as adaptor-related protein complex 1 and baculoviral IAP repeat-containing 3, were up-regulated in both drug-resistant cell types. Several genes, such as the ras homolog gene family, tropomyosin, tumor rejection antigen, protein disulfide isomerase-related protein, melanocortin 1 receptor, defensin, cyclophilin B, dual specificity phosphatase 8 and hepatocyte nuclear factor 3, were down-regulated in both drug-resistant cell types. CONCLUSION: These findings show that cDNA microarray analysis can be used to obtain gene expression profiles that reflect the effect of anticancer drugs on gastric cancer cells. Such data may lead to the assigning of signature expression profiles of drug-resistant tumors, which may help predict responses to drugs and assist in the design of tailored therapeutic regimens to overcome drug resistance.
Adaptor Protein Complex 1 ; Cisplatin* ; Cyclophilins ; DNA, Complementary* ; Drug Resistance ; Drug Therapy ; Dual-Specificity Phosphatases ; Fluorouracil* ; Gene Expression* ; Hepatocytes ; Humans ; Oligonucleotide Array Sequence Analysis* ; Receptor, Melanocortin, Type 1 ; Stomach Neoplasms* ; Transcriptome ; Tropomyosin