BACKGROUND: Ureteral stone(UTS) and acute pyelonephritis are the most common causes of nontraumatic acute flank pain in adults. Urography(IVU) is known as the most ideal diagnostic modality of obstructive uropathy to date. However, it has many practical limitations in overcrowding Korean emergency department to perform IVU as the diagnostic test of UTS. So we have performed prospective analytic study to compare IVU with its alternative diagnostic modalities. METHOD AND RESULTS: Our study was performed at Asan Medical Center from March, 1998 to July, 1999. We performed urinalysis, KUB, grayscale ultrasonography, and IVU in 243 patients, suspected to have UTS, based on histories, physical examination. After excluding patients with undetermined results(n=7) or spontaneous passage of stone before IVU(n=24), 212 patients were enrolled in our study. All of the other diagnostic tests were performed within one hour after emergency room presentation except IVU (53+/-24 hours). Diagnostic agreement among tests are as follows: Urinalysis shows good agreements with KUB(0.53) and IVU(0.62). KUB shows good agreement with IVU(0.48). Ultrasonography shows good agreement with IVU(0.58). Sensitivity(%), specificity(%), positive predicitive value(%), negative predicitive value(%), accuracy(%), and odds ratio of each diagnostic methods are as follows: Urinalysis is 91, 19, 78, 42, 74, 3.88; KUB is 55, 33, 72, 19, 50, 2.49; ultrasonography is 58, 92, 96, 41, 66, 45.61, and IVU is 81, 96, 98, 62, 84, 107.72. CONCLUSION: Although IVU seems to be the most ideal diagnostic modality for the UTS to date, it takes too long time for emergency physicians to confirm the diagnostic using IVU. We can performed other diagnostic modalities within one hour. However, emergency physicians suffer from poor diagnostic accuracy. Therefore, it is concluded that we are in need of more accurate alternative diagnostic modalities for UTS.
Adult ; Chungcheongnam-do ; Diagnosis* ; Diagnostic Tests, Routine ; Emergencies* ; Emergency Service, Hospital* ; Flank Pain ; Humans ; Odds Ratio ; Physical Examination ; Prospective Studies ; Pyelonephritis ; Ultrasonography* ; Ureter* ; Urinalysis

Accurate reproduction of intraoral tissue is essential in the fabrication of fixed prosthesis. This selection of impression material and method is very important. In this study, vinyl polysiloxane type impression material Panasil was used. Three impression methods ; one-step technique, individual tray technique, and individual tooth tray technique using the vinyl polysiloxane type bite registration material Futar Occlusion, were used to take horizontal and vertical impression. Improved stone models were fabricated. The amount of occlusal surface discrepaneies, interabutment distance discrepancies, amount of marginal defect were evaluated with the X-PLAN360d and photoscanning. The results were as follows. 1. There was no significant difference in occlusal surface according to the directions and techniques of impression taking. 2. There was no significant difference in interabutment distance discrepancies according to the directions and techniques of impression taking 3. There was no significant difference in marginal discrepancies according to the direction of impression taking but there was significant difference between one-step technique and individual tray technique, individual tooth tray technique (P<0.05). Taken together, these results suggest that individual tray technique and individual tooth tray technique are more accurate for impression taking than one-step technique.
Jaw Relation Record ; Prostheses and Implants ; Reproduction ; Siloxanes ; Tooth

Dental porcelain should have adequate strength and similar esthetics as natural teeth. Recently esthetics has become a high priority in clinical dentistry. Thus the evaluation of color stability of dental porcelain has become an important part in dental research. The purpose of this study was to evaluate the difference in color stability of 3 types of porcelain (Vintage, VMK 95, CERAMCO II). The porcelain were divided into groups by 2 types of treatment (Glazing or non-glazing and thermocycling or non-thermocycling). The porcelain wee dyed with methylene blue and distilled water, and then the color stability was evaluated with a spectrophotometer. The results were as follow ; 1. The color change of porcelain increased in the order of VMK 95, Vintage, CERAMCO II. But there was no significant difference. 2. The color change decreased in the glazing group compared to the non-glazing group(p<0.05). 3. The color change increased after thermocycling But there was no significant difference. 4. The color change according to dye method was significantly larger with methylene blue copared to distilled water(P<0.05).
Crowns* ; Dental Porcelain* ; Dental Research ; Dentistry ; Esthetics ; Methylene Blue ; Tooth ; Water

BACKGROUND: The purpose of this article was to identify the risk factors related to development of hemodynamically significant cardiac arrythmias in patients with mechanical ventilation. METHODS AND RESULTS: Holter recording and echocardiogram were performed after 30 minutes of ventilator initiation in patients on mechanical ventilation(MV) owing to respiratory failure(RF) from various reasons. From 68 patients, hemodynamically significant cardiac arrythmias were detected in 18 patients(26.5%). Initial mean arterial pressure, maximal heart rate, and initial pH were identified as risk factors for hemodynamically significant cardiac arrythmias. Additionally, the patients with pressure-controlled ventilation as an initial ventilatory mode developed hemodynamically significant cardiac arrythmias less frequently than the patients with other modes(15.8% vs. 40%, p=0.03). In multivariate analysis, initial mean arterial pressure(<70mmHg, odds ratio[OR]:5.5;95% confidence interval[CI]:1.2 to 24.2, p=0.026), maximal heart rate(>120/min, OR:19.7;95% CI:2.0 to 190.0, p=0.01), and pressure-controlled ventilation(OR:0.13,95% CI:0.03 to 0.55, p=0.006) were associated with the development of hemodynamically significant cardiac arrhythmias. CONCLUSION: Theses findings suggest that during the early stages of mechanical ventilation with acute respiratory failure, hemodynamically significant cardiac arrhythmias are directly associated with tachycardia(>120/min), initial MAP(<70mmHg), and, inversely, the initial use of pressure-controlled ventilation.
Arrhythmias, Cardiac* ; Arterial Pressure ; Heart ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Multivariate Analysis ; Respiration, Artificial* ; Respiratory Insufficiency* ; Risk Factors* ; Ventilation ; Ventilators, Mechanical

BACKGROUND: Because systolic and diastolic dysfunction frequently coexist in acute myocardial infarction(AMI), we hypothesize that a combined measure of ventricular performance using Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic chest pain. METHOD AND RESULTS: Seventy-one patients with AMI (47 male, 59+/-11 years) and 45 patients with normal coronary artery (29 male, 52+/-11 years) were included in the study for measurement of cardiac performance index and established parameters of ventricular function using conventional echo-Doppler methods. a new derived index of cardiac performance: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The mean value of the index was significantly different between normal and AMI(p<0.01). The degree of inter-group overlap was smaller for the index compared to other parameters. within functional groups, the value of the index did not appear to be related to heart rate, mean arterial pressure and the degree of mitral regurgitation. CONCLUSION: cardiac performance index is a conceptually new, simple and reproducible Doppler index of combined systolic and diastolic myocardial performance, and it is useful as screening test for patients with cardiac dysfunction due to AMI.
Arterial Pressure ; Chest Pain ; Coronary Vessels ; Echocardiography, Doppler ; Heart Rate ; Humans ; Male ; Mass Screening* ; Mitral Valve Insufficiency ; Myocardial Infarction* ; Relaxation ; Ventricular Function

PURPOSE: This study was designed to evaluate the safety and efficacy of early cessation of antibiotic treatment regardless of absolute neutrophil count in children with febrile neutropenia and no identifiable infectious source. METHODS: A prospective randomized clinical trial was performed in 93 episodes of fever in 37 neutropenic children with cancer, who were admitted to the Department of Pediatrics, Pusan National University Hospital from January 1996 to June 1997. RESULTS: Thirty-seven patients represented 93 febrile neutropenic episodes after chemotheraphy. Among them, 63 febrile episodes had no focus of fever, and there were 10 episodes of bacteremia. Of 63 febrile episodes who weren't identified focus of fever, only 47 febrile episodes had early cessation of antibiotics. During 47 febrile episodes, only 4 episodes (8.5%) had recurrent fever after early cessation of empirical antibiotic therapy. Between patients with recurrent fever and without recurrent fever, there were no significant difference in absolute neutrophil count (ANC) and CRP at admission, high body temperature before admission and duration of antibiotics. Recurrent rate of fever was high in patients who declined in absolute neutrophil count (ANC) and less than 25% increase in absolute phagocyte count (APC) at the stop of antibiotics. CONCLUSION: We suggest that early cessation of antibiotics regardless of absolute neutrophil count (ANC) is safe in the case of febrile neutropenia without an identifiable source of infection.
Anti-Bacterial Agents* ; Bacteremia ; Body Temperature ; Busan ; Child ; Febrile Neutropenia* ; Fever ; Humans ; Neutrophils ; Pediatrics ; Phagocytes ; Prospective Studies

PURPOSE: The purpose of this study was to determine the effects of self-esteem improvement program on self-esteem, depression, and interpersonal relationship in chronic schizophrenia patients living in the community. METHODS: The research design was a non-equivalent pre and post control group design. One of two community mental health centers was randomly assigned to receive the intervention and the other served as a control. Eight patients in the intervention group and ten in the control group participated. For the intervention group, the self-esteem improvement program was provided in 60-minute session once a week for 12-weeks. Measurements were Korean version of self-esteem scale (SES-K), Korean version of beck depression inventory (BDI-K), and Korean version of interpersonal relationships (IR-K). RESULTS: The only statistically significant difference between the experimental and control group was for interpersonal relationships. For the experimental group, there were statistically significant differences in self-esteem and interpersonal relationships. CONCLUSION: The results indicate that this type of program has a positive effect on self-esteem and interpersonal relationships and can be a feasible type of intervention program for community dwelling patients with chronic schizophrenia.
Community Mental Health Centers ; Depression* ; Humans ; Research Design ; Schizophrenia*

BACKGROUND: The red cell distribution width(RDW) has been reported to be of value in discriminating iron deficiency anemia(IDA) from the anemia of the other causes(non-IDA). The combination of a low MCV and a high RDW may indicate iron deficiency anemia. The purpose of this study was to discriminate IDA from anemia, using automated blood cell count alone. METHODS: We collected 139 cases of anemia in outpatients, with 80 cases of IDA and 59 cases of anemia due to other causes, from July 1995 to September 1996 in department of family medicine, Pusan Paik hospital. RESULTS: The sex distribution was 39(28.1%) in male, 100(71.9%) in female. The age distribution was 15 to 79 year. The hemoglobin level and MCV in IDA(9.5+/-1.6g/dl, 77.5+/-8.9fl) was significantly lower than those in non-IDA(10.1+/-1.5g/dl, 87.6+/-10.5fl)(P=0.042, P<0.001, respectively). And mean RDW in IDA(16.9+/-3.3%) was significantly higher than that in non-IDA(15.1+/-3.2%)(P<0.001). In discriminating IDA from anemia, we drew receiver operating characteristic curves (ROC curves) with each value of MCV and RDW. The cut-off value of MCV was 83fl, and in that value, the sensitivity and specificity were 75.9% and 72.9%, respectively. The cut-off value of RDW was 14.3%, and the sensitivity and specificity were 78.2% and 57.6 %, respectively. We combined each value of MCV with RDW, the cut off value were 83fl of MCV and 14.3% of RDW, and the sensitivity and specificity were 76.3% and 71.3%, respectively. CONCLUSIONS: The sensitivity and specificity of MCV, RDW and combination of MCV and RDW were not so high in discriminating IDA from the anemia of the other causes in ambulatory patients.
Age Distribution ; Anemia* ; Anemia, Iron-Deficiency ; Blood Cell Count ; Busan ; Female ; Humans ; Iron ; Male ; Outpatients ; ROC Curve ; Sensitivity and Specificity ; Sex Distribution

Granulocytic sarcoma is an uncommon extramedullary localized tumor composed of granulocytic precursor cells. The majority of cases have been reported in association with acute myeloid leukemia(AML) especially in children, but infrequently may occur in patients with myeloproliferative disorders or myelodysplastic syndromes. Most common sites of involvement were bone, soft tissue, lymph nodes and skin, but gastrointestinal tract, testis, central nervous system are also involved rarely. We present an unusual case of granulocytic sarcoma of the intracranium and the retro-orbital soft tissue occurring in a patient with concurrent myelodysplastic syndrome, diagnosed by brain magnetic resonance images and ultrasound guided needle biopsy.
Biopsy, Needle ; Brain ; Central Nervous System ; Child ; Gastrointestinal Tract ; Granulocyte Precursor Cells ; Humans ; Lymph Nodes ; Myelodysplastic Syndromes* ; Myeloproliferative Disorders ; Sarcoma, Myeloid* ; Skin ; Testis ; Ultrasonography

No abstract available.
Teratoma*