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

According to the autopsy study for the temporomandibular joint disc position, rotation and sideway displacements as well as anterior displacement of TMJ discs are important aspect of internal derangement. There were some trials to suspect anterior and sideway disc displacements through MR images. But the sagittal and the coronal views of MRI could only show the image of cutted slices, these images were not sufficient for showing the entire correlations amomg glenoid fossa, condylar head and articular disc. In this study we combined the images of the each slice of sagittal views like drawing a map, then we could see the interrelations among these three major components of TMJ smore precisely. Applying this method to both asymtomatic volunteers and TMD patients, we classified the interrelationships between condylar head and articular disc of TMJ as twelve types. The distributions are as follows: 1. In asymptomatic volunteers cases, normal relations were 65.0%, sideways or rotational displacements without anterior displacement were 20.0%, only anterior displacements were 15.0%, and anterior displacements combined with rotational displacements were 5.0%. 2. In unaffected sides of TMD patients, normal relations were 42.1%, rotational displacements were 11.8% and anterior displacements were 47.0%. 3. In affected sides of TMD patients, normal relations were 10.6%, sideways or rotational displacements were 13.6%, anterior displacements were 75.8%. 4. In asymptomatic volunteers or unaffected sides of TMD patients, pure anterior displacement was more prominent than combined with sideways or rotational displacement, but in affected sides of TMD patients pure anterior displacement was less prominent.
Autopsy ; Head ; Humans ; Magnetic Resonance Imaging ; Temporomandibular Joint Disc ; Temporomandibular Joint* ; Volunteers

To study factors related to release of atrial natriuretic polypeptide(ANP) in human subjects, instracardiac pressure and plasma ANP concentration in peripheral and central circulation were measured in patients with various heart disease (18 valvular heart disease, 4 congenital heart disease, 2 cardiomyopathy). 1) The concentration in peripheral venous plasma were increased in 14 patients with New York Heart Associaion (NYHA) functional class III-IV (87+/-38 pg/ml) as compared with that in 10 patients with NYHA functional class I-II (39+/-21 pg/ml, P<0.005)and 15 normal subjects (51+/-21 pg/ml, P<0.01). 2)The concentration of plasma ANP in inferior vena cava, right ventricle, pulonary artery, left ventricle and aorta were markedly increased in patient with NYHA functional class III-IV, elevated mean right atrial pressure (MRAP> or =8 mmHg) elevated mean pulmonary capllary wedge pressure (MPCWP> or =15 mmHg) and/or elevated pulminary artery systolic pressure (PASP> or =35 mmHg), as compared with those in patients with NYHA functional class I-II and/or lower intracardiac pressure (MRAP<8 mmHg, MPCWP<15 mmHg, and/or PASP<35 mmHg). 3) A step up in ANP concentration between inferior vena cava and right atrium was seen in patients with elevated MRAP (81+/-28pg/ml, 137+/-60pg/ml, P<0.05), MPCWP (74+/-37pg/ml,112+/-62pg/ml, P<0.05) and/or PASP (75+/-29 pg/ml,119+/-64 pg/ml, P<0.05). But there were no differences among intracardiac ANP concentrations from right atrium though aorta. 4) Plasma concentrations in right atrium, pulmonary artery, left ventricle and aorta correlated with MRAP (r=0.82, 0.63, 0.56, p<0.005 and r=0.52, P<0.01, respectively), MPCWP (r=0.86, 0.75, 0.73 and 0.72 respectively, P<0.005 in all) and PASP (r=0.73, 0.57, 0.68 and 0.59 respectively P<0.005 in all). 5) Left atrial diameter correlated with plasma ANP concentration in peripheral plasma (r=0.55, P<0.01), inferior vena cava (r=0.51, P<0.025), right atrium (r=0.45, P<0.05), right ventricle (r=0.55, P<0.01), pulmonary artery (r=0.52, P<0.01), left ventricle (r=0.55, P<0.01) and aorta (r=0.56, P<0.005). These results suggest that the heart secrets atrial natriuretic polypeptide into right atrium in response to increased mean right atrial pressure, mean pulmonary capillary wedge pressure, pulmonary artery systolic pressure and/or left atrial distention.
Aorta ; Arteries ; Atrial Natriuretic Factor ; Atrial Pressure ; Blood Pressure ; Heart ; Heart Atria ; Heart Defects, Congenital ; Heart Diseases* ; Heart Valve Diseases ; Heart Ventricles ; Humans ; Plasma* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Vena Cava, Inferior

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

The retrospective study was taken to study the serum transaminase level and it's correlation with several symptoms in human rotavirus gastroenteritis. 494 children, who admitted to the Department of Pediatrics in Dae Dong Hospital from January 1991 to December 1991 with chief complaints of waterdy diarrhea were included in studies. The 1st stool specimen on admission was tested for rotavirus Ag by ELLSA method. and than serum transaminase were checked. The results are as follows: 1) The peak incidence being between 6 months to 2 years in both group, but higher incidence was noted in Non-HRV group. Males are more common than females by ratio of about 2:1. 2) The major symptoms in order of frequency was diarrhea>dehydration>vomiting>coughing>fever in HRV group, diarrhea>dehydration=vomiting>fever>coughing in Non-HRV group. The incidence of dehydration and coughing in HRV group were higher than in Non-HRV group. 3) AST & ALT elevation above the normal value were 83.2% (213/256), 52.0% (133/256) in HRV group and 45.3% (116/238), 22.3% (57/238) in Non-HRV group. AST & ALT were significantly increased in HRV group than Non-HRV group (AST: p<0.05, ALT: p<0.05). 4) Mean concentration of AST & ALT were 46. 82, 38.06 in HRV group and 29.06, 21.23 in Non-HRV group. Mcan concentration of AST & ALT were significantly increased in HRV group than Non-HRV group (AST: p <0.05, ALT: p<0.05). 5) Mild dehydration is relatively more common in both group. The frequency were 56.6% (145/256) in HRV group, 47.5% (113/238) in Non-HRV group. The degree of dehydration was not correlated with serum transaminase level at each group(HRV group: p>0.05, Non-HRV group: p>0.05). 6) Duration of diarrhea for 4-5 days & 1-3 days were relatively more common in HRV group than Non-HRV group. The frequency were 36.3% (93/256) in HRV group and 34.9% (83/268) in Non-HRV group. The degree of diarrhea were not correlated with serum transaminase level at each group (HRV group: p>0.05, Non-HRV group: p>0.05). 7) No fever or duration of fever for 1-2 days were relatively more common in both group. The frequency were 39.9% (102/256), 37.5% (96/256) in HRV group and 38.2% (91/238), 42.5% (101/238) in Non-HRV group. The degree of fever was not correlated with serum transaminase level in HRV group, but correlated with Non-HRV group (HRV group: p>0.05, Non-HRV group: p<0.05).
Child* ; Cough ; Dehydration ; Diarrhea ; Female ; Fever ; Gastroenteritis* ; Humans ; Incidence ; Male ; Pediatrics ; Reference Values ; Retrospective Studies ; Rotavirus

The penetrating atherosclerotic ulcer of the aorta resulting from the atherosclerosis of the aortic wall can clinically mimic type III aortic dissection, since both diseases produce the ulceration and dissection of aortic wall. However, their imaging features and pathophsiologies are distinctly different from each other. Familial hypercholesterolemia(FH) menifests overt hyperlipidemia that can results in premature atherosclerosis of the aorta as well as the coronary artery. We report a clinically and radiologically evident case of perntrating atherosclerotic ulcer of the descending thoracic aorta which was developed in a 36-year-oldd heterozygote FH male.
Aorta ; Aorta, Thoracic* ; Atherosclerosis ; Coronary Vessels ; Heterozygote* ; Humans ; Hyperlipidemias ; Hyperlipoproteinemia Type II* ; Male ; Ulcer*

Clinical EPS was performed in 16 normal adults without evidence of conduction disease on the surface standard 12 lead electrocardiogram in order to provide normal electrophysiological values of the sinus node function and AV conduction. EPS was also performed in 15 patients with sick sinus syndrome and 10 patients with AV conduction disturbance to evaluate the clinical usefulness of EPS in detecting sinus node dysfunction and AV conduction disturbance. The results were as follows. 1) The results of sinus node function test in the normal group were m-SNRT 853+/-198msec(range 800-1,560msec), c-SNRT 230+/-66msec(range 120-370msec), and %m -SNRT/SCL 127+/-11%(range 114-149%). 2) In 15 patients with SSS, the M-SNRT were ranged from 1,270 to 12,330msec and 10 patients(66%) had significantly increased m-SNRT exceeding 1,560msec. The c-SNRT were ranged from 230 to 10,730msec and 13 patients(83%) had significantly increased c-SNRT exceeding 370msec. The % m-SNRT/SCL were ranged from 136 to 770% and 12 patients(80%) had significantly increased % m-SNRT/SCL exceeding 150%. 3) The SACT in normal group were 84+/-14msec(range 70-105msec) measured by continuous atrial pacing method and 80+/-19 msec(range 60-115msec) measured by atrial extrastimulation method. 4) In SSS, the SACT measured by continuous atrial pacing method was ranged from 80 to 1,050msec and 11/12 patients(92%) had significantly increased SACT exceeding 112 msec. The SACT measured by atrial extrastimulation method was ranged from 90 to 310msec and 7/8 patients(88%) had significantly increased SACT exceeding 118 msec. 5) C-SNRT, % m-SNRT/SCL, and SACT were more useful in detecting sinus node dysfunction than m-SNRT. 6) The AV conduction intervals in normal group were PA interval 17+/-6(range 5-25msec), AH interval 96+/-18 msec(range 70-135msec), and HV interval 46+/-7msec(range 35-55msec). 7) Rapid atrial pacing induced Wenckebach type second degree AV block proximal to H at pacing rate of 90 to 190/min in 14/16 normal adults. 2 patients maintained intact AV conduction upto maximum pacing rate of 200/min. 8) His bundle electrogram showed the site of AV block in 9 of 10 patients with AV conduction disturbances. The sites of AV block were AV nodal area 1 case, intraHis bundle 4 cases, and infraHis bundle 4 cases. 9) EPS provided a good supportive information that was useful in selecting pacemaker therapy in a patient with chronic bifascicular block who revealed prolonged HV interval and infraHis bundle block at a pacing rate of 70min. 10) The refractory periods of AV conduction system in normal group were AERP 274+/-54msec (range 170-410msec), AVN-FRp 467+/-74msec(range 285-600msec), AVN-ERP 341+76msec(range 190-460), and V-ERP 280+/-25msec(range 240-320msec).
Adult ; Atrioventricular Block ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Humans ; Sick Sinus Syndrome ; Sinoatrial Node*

The purpose of this study was to investigate effects of nutrition education program and pamphlet for the lower grades elementary students focused on individual daily needed food exchange units using Food Exchange System. Program consisted of four lessons (40 min/lesson), "5 major nutrients & function", "6 food group and sources", "daily needed food exchange units for normal body weight", and "smart snack choice and exercise". Pamphlet as activity book was developed for the program. The subjects were 3rd grade elementary students (educated group, 31 vs. non-educated group, 31). Educated group were lessoned as group and/or individual. We examined the differences in nutrition knowledge, dietary attitudes, dietary intakes and satisfaction of the program and pamphlet. In educated group, there were positive improvements on nutrition knowledge score "function and foods of 5 nutrients" and on dietary attitudes "type of breakfast and snacks". In the evaluation of dietary intakes according to KDRI, there were positive improvements on intakes level of riboflavin, vit. C, folate, Ca, P, Fe and Zn in educated group. In satisfaction with the program and pamphlet, contents, font size, visual, figure, difficulty and program curriculum were over 2.90/3.0. It showed that the developed nutrition education program and pamphlet focused on individual daily needed food exchange units using Food Exchange System improved nutrition knowledge, dietary attitudes and nutrients intake level in the lower grades elementary students.
Breakfast ; Curriculum ; Folic Acid ; Humans ; Pamphlets ; Riboflavin ; Snacks

Cisplatin has been widely used as chemotherapeutic agent for the treatment of cervical cancer, ovarian cancer, head and neck cancer and squamous cell carcinoma of lung. But cisplatin is highly toxic with nephrotoxicity, gastrointestinal toxicity, myelosuppression and neurotoxicity. The second generation drug of platinum compound, carboplatin was developed in 1980s to reduce side effects. Carboplatin has low nephrotoxicity but its major toxic effect is thrombocytopenia, In this study, the side effects of cisplatin and carboplatin were evaluated on 37 patients of cervical cancer in 169 chemotherpy cycles who were recieved combined VBP chemotherpeutic regimen consisting of cisplatin or carboplatin. Nephrotoxicity of grade 2 or over were 16% in cisplatin group and 1% in carboplatin group. Granulocytopenia of grade 2 or over were 34% in cisplatin group and 10% in carboplatin group. Thrombocytopenia of grade 2 or over were 7% in cisplatin group and 21% in carboplatin group. Gastrointestinal toxicity of grade 2 or over were 11% in cisplatin group and 0% in carboplatin group. This clinical study demonstrated that cisplatin has more toxic effects than carboplatin except thrombocytopenia.
Agranulocytosis ; Carboplatin* ; Carcinoma, Squamous Cell ; Cisplatin* ; Drug Therapy, Combination* ; Head and Neck Neoplasms ; Humans ; Lung ; Ovarian Neoplasms ; Platinum ; Thrombocytopenia ; Uterine Cervical Neoplasms

No Abstract Available.
Cicatrix* ; Cleft Lip* ; Congenital Abnormalities* ; Nose*