BACKGROUND AND OBJECTIVES: This study was designed to assess the characteristics of patients according to the degree and audiogram shape of hearing loss and the association of these characteristics with hearing aids (HA) choice, return rate, and cause of return. SUBJECTS AND METHODS: This study included 460 individuals who received HAs from 2011 to 2015. The relationships between type of HA and age, primary and accompanying symptoms, HA choice and return and cause of return were evaluated according to the degree and pattern of hearing loss. RESULTS: HA type did not differ significantly according to the degree and pattern of hearing loss. Intensity of hearing loss was greater in male than in female (p<0.05). Open and completely-in-canal types of HA decreased with age (p<0.05). As degree of hearing loss intensified, behind-the-ear and in-the-ear types increased and Open type decreased (p<0.05). The HA return rate was 9.7%, but was not associated with degree or pattern of hearing loss. The main causes of HA return were costs, psychological fears and adaptive failure. CONCLUSIONS: Choice of HA is affected by age, sex, and degree and pattern of hearing loss. HA for hearing rehabilitation in patients with hearing loss can be personalized according to each patient's characteristics and tendencies.
Female ; Hearing Aids* ; Hearing Loss* ; Hearing* ; Humans ; Male ; Rehabilitation

The aim of this project was to use 3D scanning data collected at incident scenes and various evidence to 1) develop surveying methods based on 3D data consisting of overall and detailed scene evidence, captured by long-range and micros-canner, which can be shared by personnel working in different fields such as forensic medicine, video analysis, physical analysis, traffic engineering, and fire investigation; 2) create digital storage for human skeletons and set the foundation for virtual anthropology; and 3) improve the credibility of 3D evidence by virtual remodeling and simulation of incident scenes and evidence to provide a basis for advanced and high-tech scientific investigation. Two complete skeletons of male and female were scanned using 3D micro-scanner. Each bone was successfully reproduced and assembled in virtual space. In addition, recreating evidence scheduled for invasive examination by creating RP (rapid prototype) was possible. These outcomes could play an important role in setting up the new field of virtual anthropology. Case-specific surveying methods were developed through analysis of 3D scanning data collected by long-range surface scanners at the scenes of vehicular accidents, falls, shootings, and violent crimes. A technique and recording method was also developed for detecting forged seals by micro-scanning the pressure exerted on the seal. Appraisal methods developed in this project could be utilized to secure 3D data of human skeletal remains and incident scenes, create a standard for application, and increase objectivity, reproducibility, and accuracy of scanning methods. We plan to develop case-specific 3D data analysis techniques to improve the credibility of analysis at the NFS and to establish a 3D data collection and analysis team.
Crime ; Data Collection ; Female ; Fires ; Forensic Medicine ; Forensic Sciences ; Humans ; Male ; Skeleton ; Statistics as Topic

BACKGROUND AND OBJECTIVES: High-dose intravenous immunoglobulin (IVIG) (2 g/kg) is usually given in the treatment of Kawasaki disease (KD). According to the authors' experience, however, medium-dose immunoglobulin (1 g/kg) was also effective in the majority of patients. We performed a retrospective clinical study to validate effectiveness of the medium-dose regimen in treatment of KD. SUBJECTS AND METHODS: A total of 274 patients with KD who were treated with medium-dose immunoglobulin at Bundang Jesaeng General Hospital from July 1998 to October 2007 were enrolled. RESULTS: Medium-dose immunoglobulin was given once in 220 patients (group A; 80.3%) and twice or more in 54 patients (group B; 19.7%). Age and gender distributions, duration of fever before treatment, hemoglobin concentrations, and white blood cell and platelet counts did not differ significantly between the two groups (p>0.05). Concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase, and bilirubin were significantly higher in group B (p<0.005). Coronary arterial lesions (CAL) were found in 51 patients (23.2%) in group A and in 26 patients (48.1%) in group B during the acute stage, and in 14 patients (6.4%) in group A and in 11 patients (20.4%) in group B during the convalescent stage (p<0.005, respectively). A giant aneurysm was found in one patient in each group (0.5% in group A and 1.9% in group B; p<0.005) during the follow-up period. CONCLUSION: A single infusion of medium-dose immunoglobulin was effective in 80% of patients with KD. About 20% of patients required two or more infusions of medium-dose immunoglobulin, who had higher concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase and bilirubin. The authors think that the medium-dose regimen proffers an advantage over the high-dose regimen in view of cost-effectiveness.
Alanine Transaminase ; Aneurysm ; Aspartate Aminotransferases ; Bilirubin ; C-Reactive Protein ; Fever ; Follow-Up Studies ; Hemoglobins ; Hospitals, General ; Humans ; Imidazoles ; Immunoglobulins ; Infusions, Intravenous ; Leukocytes ; Mucocutaneous Lymph Node Syndrome ; Nitro Compounds ; Platelet Count ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Leptin is a hormone that involves control of body weight, energy expenditure and respiration. Leptin levels are high not only in obese patients, but also in obstructive sleep apnea syndrome (OSAS) patients, independent of body weight. Leptin levels decrease significantly following continuous nasal positive airway pressure treatment in OSAS patients without any change of body mass index (BMI). The aim of this study is to evaluate the effect of surgical treatments on plasma leptin level in patients with OSAS and to investigate the relationship of the change of plasma leptin level with that of daytime sleepiness after surgical treatments. SUBJECTS AND METHOD: We measured plasma leptin levels in patients diagnosed as OSAS before and 2 months after surgical treatment and also checked Epworth Sleepiness Scale (ESS) scores before and after treatment. We then compared plasma leptin levels and ESS scores, scales of daytime sleepiness preoperatively with those obtained postoperatively. We checked the relationship between changes of plasma leptin level and those of ESS scores. RESULTS: The plasma leptin level decreased significantly after surgical treatment in patients with OSAS without any significant changes in BMI. Also, the change of serum leptin level after surgical treatment had a positive correlation with that of ESS scores. CONCLUSION: Leptin is a hormone affected by surgical treatment in patients with OSAS and its level has a positive correlation with daytime sleepiness, one of the symptoms of patients with OSAS.
Body Mass Index ; Body Weight ; Energy Metabolism ; Humans ; Leptin* ; Plasma* ; Respiration ; Sleep Apnea, Obstructive* ; Weights and Measures

Gestational trophoblastic disease is derived from the intermediate trophoblast cells which are arisied from the fetal chorion. The incidence of invasive mole in Korea was about 1.8 per 1000 delivereies. The rate of ectopic pregnancy is about 1.9% of all pregnancies. An ectopic pregnancy located in the cornual portion of uterus occurs in only 2-4% of all ectopic pregnancies. It is rare that the invasive mole is associated with cornual pregnancy. A case of metastatic invasive mole in the lung arising from a cornual pregnancy is reported, which was cured by operation and combination chemotherapy.
Chorion ; Drug Therapy, Combination ; Female ; Gestational Trophoblastic Disease ; Hydatidiform Mole, Invasive* ; Incidence ; Korea ; Lung* ; Pregnancy ; Pregnancy* ; Pregnancy, Ectopic ; Trophoblasts ; Uterus

BACKGROUND AND OBJECTIVES: Dizziness and vertigo are frequent causes of presentation in the emergency center. Nevertheless, the practice guideline for the primary care doctor in the emergency center has not been reported yet. Considering its complex approach for diagnosis, we developed critical pathway for dizzy patients who visited emergency center. We performed this study to show the process of development and the result of implementation of critical pathway. MATERIALS AND METHOD: A critical pathway was developed following the analysis of dizzy patients visiting emergency center by retrospective chart review and in the basis of questionnaire for knowing the needs for critical pathway to the primary care doctor in emergency center. Specialists for caring dizzy patients joined to make the flow sheet and practice guideline for dizzy patients and also made educational materials for doctors in emergency center. The critical pathway was then implemented and its results were analyzed by estimating the practice time and the degree of satisfaction of the patients and doctors. RESULTS: Most of the primary care doctors in emergency center reported the difficulty in diagnostic approach for dizzy patients and the need for critical pathway. More than half of the dizzy patients were diagnosed as peripheral vertigo and the commonest disease was benign paroxysmal positional vertigo. All of the patients with vertigo diagnosed as central origin showed the neurologic deficit. After the implementation of critical pathway, practice time was significantly decreased and many of the dizzy patients and doctors were satisfied. CONCLUSION: Development and implementation of a critical pathway for dizzy patient in emergency center was possible, valuable and effective for the patients and doctors, though the process was not easy and needed interdisciplinary cooperation of involving departments.
Critical Pathways* ; Diagnosis ; Dizziness ; Emergencies* ; Humans ; Neurologic Manifestations ; Primary Health Care ; Surveys and Questionnaires ; Retrospective Studies ; Specialization ; Vertigo

PURPOSE: Spinal cord injury without radiographic abnormality (SCIWORA) usually has been documented in pediatric patients. We report 8 cases of SCIWORA in adult and evaluate the diagnostic and prognostic value of MRI in SCIWORA. METHODS: We retrospectively studied adult patients who presented to the emergency room of a tertiary army hospital with SCIWORA, from Jan. 2001 to Dec. 2002. We reviewed the patient 's medical records, plain films, CT and MRI findings. RESULTS: There were 8 patients of SCIWORA during 2 years. Major mechanisms of injuries were sports-related injury (62.5%) and fall (25%). They presented with central cord syndrome (62.5%), Brown-Sequard syndrome (12.5%), monoparesis (12.5%), and sensory symptom only (12.5%). All patients were checked with MRI and five patients (62.5%) showed abnormal MRI findings including spinal cord hemorrhage, edema, and disc herniation. All patients received megadose methylprednisolone therapy, and three underwent operations. Patients, who had been recovering at the time of admission to our ER, had normal MRI findings, and all patients with normal MRI findings had full neurological recovery within 3 days. Only two patients had neurological sequelae, and their MRI findings were spinal cord hemorrhage and herniated disc with cord compression, respectively. CONCLUSION: SCIWORA in adults, even though rare, exists, and MR imaging findings determine treatment plan and neurological outcome of patients.
Adult ; Brown-Sequard Syndrome ; Central Cord Syndrome ; Edema ; Emergency Service, Hospital ; Hemorrhage ; Hospitals, Military ; Humans ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging* ; Medical Records ; Methylprednisolone ; Paresis ; Radiography ; Retrospective Studies ; Spinal Cord Injuries* ; Spinal Cord*

PURPOSE: This study was designed to evaluate the characteristics of exertional heat stroke between the non-survival and the survival groups. METHODS: From January 1996 to December 2002, patients with exertional heat stroke who came to the emergency department of a military hospital were enrolled. Data on individual factors, atmospheric conditions, pre-hospital management, initial vital signs, laboratory findings, presence of seizure attack, and performance of intubation were reviewed retrospectively and compared between the nonsurvival and the survival groups. RESULTS: During the study period, 22 patients were diagnosed as suffering from exertional heat stroke and 5 patients died. Most of the episodes occurred during the summer days with high ambient temperature (mean 30.6+/-3.0 degrees C) and humidity (mean 75.6+/-7.7%), and 13 patients were unacclimatized recruits. The non-survival group showed a lower initial systolic blood pressure, platelet count, arterial pH, and HCO3 - level, and a higher serum creatinine, ALT, and amylase level than did the survival group (p<0.05). However there were no significant differences in individual factors, atmospheric conditions, pre-hospital management, initial pulse rate, temperature, white blood cell count, hemoglobin count, and the sodium, potassium, BUN and AST levels between the two groups. CONCLUSION: Initial systolic blood pressure, platelet count, and arterial pH, as well as HCO3 -, serum creatinine, ALT, and amylase levels seem to be important factors for the prognosis of exertional heat stroke.
Amylases ; Blood Pressure ; Creatinine ; Emergency Service, Hospital ; Heart Rate ; Heat Stroke* ; Hospitals, Military ; Hot Temperature* ; Humans ; Humidity ; Hydrogen-Ion Concentration ; Intubation ; Leukocyte Count ; Military Personnel* ; Platelet Count ; Potassium ; Prognosis ; Retrospective Studies ; Seizures ; Sodium ; Vital Signs

PURPOSE: This study was conducted to confirm the effects of octreotide in patients with variceal bleeding. METHODS: We performed a retrospective analysis of 26 patients with variceal bleeding, who visited the Emergency Center of Seoul National University Hospital from January 1st to June 31st, 1996, the control group, and a prospective analysis of 28 patients with variceal bleeding, who visited the Emergency Center of Seoul National University Hospital from March 1st to August 31st, 1999, for the octreotideinfused group. The octreotide-infused group recieved a continuous infusion of octreotide, 25 microgram/hr, for 5 days after an initial bolus of 50 microgram. When active bleeding continued over 1 hour, over 5 pints of packed-RBC were needed for transfusion within 24 hours, or when the systolic blood pressure was under 90 mmHg, a ballon tamponade with Sengstaken-Blackemore tube was used. T-test and X2 test were used for statistical analysis(p<0.05). RESULTS: Forty-one patients were male(octreotide-infused group 22, control group 19) and 13 were female(octreotide-infused group 6, control group 7). The mean age was 55 years(octreotide-infused group 56 years, control group 52 years). There were no significant differences in vital signs, hemoglobin/hematocrit levels, and Child-Pugh's classifications between the octreotide-infused group and the control group initially. There was a significant difference in the rates of early bleeding control within 24 hours(p<0.05), but there were no significant differences in the rates of rebleeding, mortality within 1 week, and use of a balloon tamponade. CONCLUSION: Variceal bleeding is a serious complication of liver cirrhosis and has a high mortality rate. Octreotide is an effective vasoactive agent for control of early bleeding. Thus, octreotide should be used first before endoscopic definitive therapies, to stabilize the vital signs of patients and to secure a field for endoscopic procedures.
Balloon Occlusion ; Blood Pressure ; Classification ; Emergencies ; Esophageal and Gastric Varices ; Hemorrhage* ; Humans ; Liver Cirrhosis ; Mortality ; Octreotide* ; Prospective Studies ; Retrospective Studies ; Seoul ; Varicose Veins* ; Vital Signs