BACKGROUND: To provide basic data to help construct regional EMSS. METHOD: Using preformed questionnaire, authors investigated prospectively data of 214 patients transferred directly to emergency medical center from other hospitals from May 11 to june 10,1998. RESULTS: 1. Total 214 patients were transferred directly to the emergency medical center of KNUH (14.4% of total), and 63.5% of patients excluding children were non-traumatic patients. 2. The peak age group was 5th decade (19.6%) with mean age of49.6 years old. The male to female ratio was 1.8 : 1. 3. The period between 08 : 00 to 16 : 00 was the most frequent arrival time of transfer patients (42.5%), and the proportion of patients for surgical departments were more common than those for other departments (53.7%). 4. the majority of patients were transferred from secondary hospitals (91.6%), but among them the proportion of mild non-traumatic and mild traumatic patients was 52.3%, and 72.0%. 5. The decision-maker for transfer was a patient himself or family members in 32.3% of severe and 26.8(/) of mild non-traumatic patients, compared with 37.5% of severe and 26.8% of mild traumatic patients. 6. The physician-to-physician communication prior to the patient's transfer was not carried out in 90.8% of severe and 85.9% of mild non-traumatic patients, compared with 75.0%of severe and 67.0%of mild traumatic patients. 7. The hospital ambulance was the most common mode of transfer (64.5%), but non-emergency vehicles such as a taxi or a private car was used for transfer in 21.5% of severe non-traumatic patients, and 12.5% in severe traumatic patients. 8. Transfer accompanied by medical personnel took place in 15.4% of severe non-traumatic patients, 25.0% in severe traumatic patients, and in 27.0% of severe non-traumatic patients, and 44.4% in severe traumatic patients transferred 4 by hospital ambulance. 9. Transfer took less than 1 hour in 66.9% of non-traumatic patients, and 45.2% of traumatic patients, but it took 1 hour or more in 27.7% of severe non-traumatic patients, and 43.7% of severe traumatic patients. 10. Transfer record accompanied the patient in 90.2% of total, but radiologic film and results of laboratory tests did not in 36.9% and 56.9% of severe non-traumatic patients, and in 12.5% and 43.7% of severe traumatic patients. CONCLUSION: It is considered that an appropriate triage system, interhospital transfer guidelines, good transfer records, cooperative interhospital communication, emergency medical information center, public information with education about regional EMSS, improvement of equipment in ambulance, and training of emergency personnel are necessary for effective and well-organized EMSS.
Ambulances ; Child ; Education ; Emergencies* ; Female ; Humans ; Information Centers ; Male ; Prospective Studies ; Surveys and Questionnaires ; Triage

No abstract available.
Rectum*

OBJECTIVE: The purpose of our study evaluate to assess the feasibility and safety of performing vaginal hysterectomy on our experience. METHODS: Between 1990 year and 1997 year, 3408 women underwent vaginal hysterectomy without laparoscopic assistance at Hallym University Hospital in Korea. All hysterectomies(abdominal & vaginal) were reviewed and these were compared with all hysterectomy cases from most recent year available for complete analysis. RESULT: 1. In 1990 yrs~1997 yrs, vaginal hysterectomies compromised 51%(vaginal hysterectomy [below VH]: 268 / total abdominal hysterectomy [below TAH]: 258; 1990), 55%(VH: 254/TAH: 212; 1991), 60%(VH: 346/TAH: 227; 1992), 64%(VH: 341/TAH: 190; 1993), 72%(VH: 434/TAH: 168; 1994), 75%(VH: 489/TAH: 156; 1995), 76.%(VH: 632/TAH: 196; 1996), 78%(VH: 657/TAH: 190;1997), a high increased rate of vaginal hysterectomy significantly. 2. The average age of patients was 41.9+/- 8.18(26~84) years old and 25 nullipara and 274 primiparas and 3109 multiparas. The mean parity was 2.74+/-0.36. 3. The common surgical indications were uterine myoma(53.9%), prolapse of uteri(23.3%), CIN II-III or microinvasive cervical cancer(6.5%), others(16.3%) 4. The average time of operation(hysterectomy and colporrhaphy) was 78.3+/- 14.2 min(40~230). 5. The average weight of uterus was 166.5+/- 111.4 gm(60~1130 gm), 34.0% was done morcellation. 6. 5.7% of operated women had previous abdominal operaton (without tubal ligation). 7. The common associated procedures were posterior colporrhaphy(47.4%), anteroposterior colporrhaphy(45.6%), adnexectomy(4.9%), other(2.1%). 8. The mean blood loss was 280+/- 104.4 ml and 12.4% of operated women were need of transfusion. 9. The minor complication rate was 10.6% e.g. urinary retention(5.3%-179cases), abdominal bleeding (including conversion TAH) (0.3%-9cases), pelvic hematoma(0.3%-11cases), post operation fever(2.8%-94cases), mortality cases none. 10. The mean hospital days were 7 days(4~20) CONCLUSION: In our experience the following conclusions have been reached that vaginal hysterectomy is usually well tolerated by most women, a safe operation with few complications and without notable blood loss and without the need of expensive laparoscopic equipment. The incidence of vaginal hysterectomy is characterized by pronounced fluctuations suggested that no valid general guidelines have yet been established for the indication via vagina of surgical treatment. The incidence of vaginal hysterectomy correlates with the experience of individual surgeon strongly. Vaginal hysterectomy remains the method of choice for removal of the uterus in the absence of absolute contraindication.
Female ; Hemorrhage ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal ; Incidence ; Korea* ; Mortality ; Parity ; Prolapse ; Uterus ; Vagina

OBJECTIVE: To review recurrence and prognosis of microivasive squamous cell carcinoma of the cervix that are associated with depth of invasion, pathologic finding and management(conservative or radical treatment) STUDY DESIGN: We conducted retrospective study in order to evaluate the results of therapeutic approaches in 46 patients with microinvasive cervical cancer from Jan 1987 to Oct 1996. RESULT: The mean age of patients was 44.6+ 8.86 years. Only one woman was nullipara, and the mean parity was 2.8, Overall diagnostic accuracy of pap smear and punch biopsy were 54.3% and 79.4%. As the depth of invasion was deeper, the diagnostic accuracy of punch biopsy increased(p<0.05), The confluence pattern and lymphovascular space involvement were observed in 39.1% and 4.9%. The confluence pattern was observed with statistical significant in advanced depth of stromal invasion. In the surgical management, vaginal hysterectomy was done in 28 patients, conization(l patient), total abdominal hysterectomy(8 patients) and radical hysterectomy with pelvic lymph node dissection(9 patients) was done, no positive node was in 104 pelvic lymph node dissected. Though all cone margin was free and all endocervical curettage was negative, residual lesion(2 patients) was present in the hysterectomy after conization, The median follow-up period was 64 months. There was no recurrence in all cases and 5 years survival rate was 100% CONCLUSION: We suggest that microinvasive carcinoma of the cervix may be the disease of good prognosis and no recurrence, and less radical therapy for the patients with microinvasive carcinoma may be sufficient.
Biopsy ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Conization ; Curettage ; Diagnosis* ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Lymph Nodes ; Parity ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms

No abstract available.
Ascitic Fluid* ; Endometriosis* ; Female ; Humans ; Interleukins*

To evaluate the effect of Perindopril in patients with essential hypertension, we administered Perindopril 4 to 8mg/day once daily to 30 patients(18 males, 12 females) for 12 weeks. Baseline blood pressure after 4 weeks with placebo was 150.4+/-7.5/102.0+/-4.3mmHg. The blood pressures of the patients were declined significantly at 4th(140.6+/-14.9/95.4+/-6.5), 8th(136.7+/-11.4/91.7+/-7.6), and 12th(132.3+/-11.1/87.5+/-6.9) week(p<0.01) without change of heart rate. The blood pressure of the patients was normalized below 140/30mmHg in 24 patients(80%) and declined diastolic blood pressure more than 10mmHg in one patients. Therefore the response rate of perindopril was 83.3%. There were reported 3 patients who revealed mild adverse reactions as follows; cough, indigestion, dizziness in one each. In conclusion, these results indicate that antihypertensive therapy with perindopril single daily dose was effective in patients with mild to moderate essential hypertension and well tolerated.
Blood Pressure ; Cough ; Dizziness ; Dyspepsia ; Heart Rate ; Humans ; Hypertension* ; Male ; Perindopril*

BACKGROUND: Hyperlipidemia is the one of the major risk factors causing the atherosclerosis of coronary arteries. Treatment of hyperlipidemia with drugs has been confirmed the effects of therapy showing a decreased incidence of coronary artery disease. Pravastatin is one of the new HMG-CoA reductase inhibitors and we studied the short-term hypolipidemic effects and safety of pravastatin in patients with hyperlipidemia. METHODS: We studied 31 patients(7 males and 24 females ; range of age, 36-67 years) for 12 weeks whose plasma levels of total cholesterol were higher than 250mg% after one month period of diet therapy. Pravastatin was administered 10mg/day and measured lipid profiles at 4 week interval. RESULTS: Pravastatin reduced the plasma total cholesterol from 286.2mg% to 212.3mg% (25.9%), the LDL-cholesterol from 204.2mg% to 143.6mg% (29.7%), the triglyceride from 226.0mg% to 161.4mg% (28.6%) after 12 weeks treatment. The HDL-cholesterol increased from 25.8mg% to 46.4mg% (20.5%) after pravastatin therapy. These changes were disclosed all statistically significant compared to baseline levels(p<0.01). The clinical and laboratory examinations before and after pravastatin treatment showed no particular abnormal findings. CONCLUSIONS: These results suggested that short-term pravastatin therapy in patients with hyperlipidemia seems to be very effective and safe.
Atherosclerosis ; Cholesterol ; Coronary Artery Disease ; Coronary Vessels ; Diet Therapy ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hyperlipidemias* ; Incidence ; Male ; Plasma ; Pravastatin* ; Risk Factors ; Triglycerides

BACKGROUND: Diabetic ketoacidosis(DKA) is serious acute metabolic complication and the most important cause of high morbidity and mortality of diabetes. The object of this study is to examine the clinical characteristics of patients with DKA who had a prior history of diabetes or not. METHOD: Authors reviewed retrospectively the medical records of 49 cases adimitted to Kyungpook National University Hospital from January 1991 to June 1997 with a diagnosis of DKA and classified cases as type I, type II and newly diagnosed diabetics according to prior history of diabetes. RESULTS: 1. Of 49 cases of DKA, 24(49%) were classified as type I, 17(35%) as type II from data available in the medical records, and 8(16%) had DKA as the initial manifestation of the disease. 2. The male to female ratio was 0.5 : 1 in type I, 1.1 : 1 in type II and 1.7 : 1 in newly diagnosed diabetics, and the mean age was 24.4 in type I, 57.9 in type II and 23.9 years old in newly diagnosed diabetics. 3. The mean duration between initial diagnosis of diabetes and the occurrence of DKA was 2.6 in type I and 6.9 years in type II diabetes. The occurrence of DKA within 2 years of initial diagnosis of diabetes was 54% in type I and 18% in type II diabetes, but the occurrence of DKA after 5 years of initial diagnosis of diabetes was 17% in type I and 47% in type II diabetes. 4. The precipitating factors of DKA were identified in 88% in type I, 76% in type II and 38% in newly diagnosed diabetics, and the most common precipitating factor was omission of treatment in both type I and type II(type I: 56%, type II: 35%). 5. The altered mental status was correlated with increased osmolality (p<0.05), but not with other laboratory values such as pH, bicabonate, glucose, anion gap and dehydration status(p>0.05). CONCLUSION: It is necessary to conduct early aggressive evaluation for early diagnosis and proper treatment of DKA, because DKA occurs in patients with prior history of type II diabetes and without prior diabetic history as well as patients with prior history of type I diabetes.
Acid-Base Equilibrium ; Dehydration ; Diagnosis ; Early Diagnosis ; Female ; Glucose ; Gyeongsangbuk-do ; Humans ; Hydrogen-Ion Concentration ; Male ; Medical Records ; Mortality ; Osmolar Concentration ; Precipitating Factors ; Retrospective Studies

No abstract available.
Cervix Uteri* ; Female ; Hysterectomy*

Hypertonic or hypernatremic dehydration, which is uncommon in pediatric patients beyond infancy, has a distinct pathophysiology that differentiates the clinical presentation and management from other forms of dehydration. Severe hypernatremia may precipitate central nervous system injury, seizures, intracerebral bleeding, retardation, and even death. Causes of hypernatremia include inadequate water intake, salt overload, extrarenal water loss, defective osmoregulation, and water loss with simultaneous gain of solute. We experienced a case of hypernatremia due to esophageal foreign body. These authors reported a case with review of literatures.
Central Nervous System ; Dehydration ; Drinking ; Foreign Bodies* ; Hemorrhage ; Humans ; Hypernatremia* ; Osmoregulation ; Seizures