PURPOSE: In this research, a definition of overcrowding in emergency department (ED) was proposed, and the actual state of overcrowding in ED was measured by surveys and extensive statistical analysis of data using objective variables. METHODS: The emergency physicians (EP) of 10 arbitrarily selected hospitals were questioned about the definition and cause of overcrowding in ED. The hospitals were divided into two groups (high-feeling and low-feeling) in accordance with the survey results. Admission/discharge records of the patients including arrival/departure date and time, were also collected for the duration of 4 weeks with consideration of seasonal variations, from March 2002 to March 2003. Four parameters, the bed ratio (BR), the provider ratio (PR), the acuity ratio (AR), and the demand value (DV), which were used for the evaluation of overcrowding, were calculated for each hospital. A statistical analysis was carried out to see whether any difference existed in the BR, the PR, the AR and the DV between weekends and weekdays. Also, a similar statistical method was used to analyze the differences between the high-feeling group and the low feeling group. RESULTS: In the survey, 83 physicians were asked to answer the questions. The most preferred answers (>70%) for the definition of overcrowding were "saturation of the beds in the ED for more than 6 hours a day."For the cause of overcrowding, the popular answers were "delay in the consultation and the disposition decision" (74.7%), "use of the ED by non-urgent patients"(74.7%), and "lack of inhospital beds"(65.1%). Among the 10 hospitals, 5 hospitals were categorized the high-feeling group, and the rest fell into the low-feeling group. The average BR and AR were higher in high-feeling group than those of low-feeling group (p<0.01, p<0.01). However, average PR of low-feeling group was higher than that of high-feeling group (p<0.01). Average DV did not exhibit any difference between the two groups (p=0.31). CONCLUSION: The definition of overcrowding in the ED should include not only the lack of beds in the ED but also patient's acuity and the lack of providers. Certain aspects of overcrowding are clearly different between the high-feeling and the low-feeling groups.
Crowding ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Seasons ; Tertiary Care Centers*

No abstract available.
Germ Cells* ; Klinefelter Syndrome* ; Neoplasms, Germ Cell and Embryonal*

BACKGROUND AND OBJECTIVES: Flow-mediated brachial artery vasoactivity has been recently proposed as a noninvasive means for assessing endotheial function. This endothelial function is impaired in certain cardiovascular conditions, including essential hypertension. METHODS: The study population included 50 healthy subjects aged 22 to 62 years (mean+/-SD, 42+/-12 years), all normotensive, nondiabetic with cholesterol level <220 mg/dL and no family history of premature vascular disease. Normal subjects were classified according to age into those younger than and those older than 40 years. Using high-resolution ultrasound, brachial artery diameter and flow were measured at rest, during reactive hyperemia (with flow increase causing flow-mediated dilation [FMD], which depends on normal endothelial function), and after sublingual nitroglycerin, an endothelium-independent vasodilation. To better characterize this technique, this study was an attempt to assess the flow-mediated vasodilation in two separate protocols (as follows); (1) the stimulus response to various duration of occlusion (using 1 and 5 min), and (2) the stimulus response to various pressure of occlusion (using low and high pressure). In 28 patients (mean+/-SD, 52+/-7 years) with essential hypertension, this study was additionally evaluated endothelial function. The measurements have been compared with those of 14 healthy control subjects. In all subjects, the intima-media thickness (IMT) of the common carotid artery was also measured. This study sought to 1) determine whether endothelial dysfunction was presented in patients with essential hypertension, and 2) examine IMT in these patients. RESULTS: 1) Both in the younger and the older groups, the basal diameter and flow of the brachial artery were significantly increased in men than women. The values were 4.4+/-0.1 mm and 186+/-16 ml/min in men and 3.6+/-0.09 mm and 125+/-13 ml/min in women (p<0.001; p<0.01). In subjects younger than 40 years, flow-mediated dilation (FMD) and the difference in flow response were similar between men and women. But, in subjects older than 40 years, FMD was decreased in men than women (6.6+/-1.6 vs. 14.7+/-1.6%. p<0.01) and the difference in flow response was also decreased in men than women (217+/-24.3 vs. 314+/-40.5%, p<0.05). In younger and older groups, there were no significant change in the nitroglyserin response in either gender. 2) Fifteen normal subjects underwent sequential evaluation following 1 and 5 min of upper arm blood pressure cuff occlusion. There were substantial increase in brachial artery diameter and flow immediately after release of 1 and 5 min of occlusion. The FMD and the difference in flow response following release of occlusion between 5 min duration (11.5+/-1.9%, 253+/-36%) and 1 min duration (6.6+/-1.2%, 53+/-11%) were statistically significant (p<0.05; p<0.001). But, the percent change of diameter following release of occlusion between 5 and 1 min was not statistically significant (p<0.05). 3) Fourteen normal subjects was evaluated the effects of various pressure on endothelial cell function. Inflation pressure was maintained at 30 mm Hg higher than systolic pressure for 5 min and 200 mm Hg (70-90 mm Hg higher than systolic pressure) for 5 min in a random fashion, and then the cuff was suddenly deflated. The diameter and flow response following release of occlusion between high and low pressure were not statistical significance (p>0.05). 4) Flow-mediated dilatation was significantly lower in patients with essential hypertension than in normotensive control subjects (4.2+/-0.8 vs. 7.3+/-1.3 %, p<0.05). Intima-media thickness was significantly higher in patients with hypertension than in normotensive control subjects (0.82+/-0.04 vs. 0.64+/-0.04 mm, p<0.05). Nitroglycerin-mediated vasodilation (9.5+/-1.4 %) in patients with essential hypertension did not differ significantly from those in normotensive control subjects (10.0+/-2.6%, p>0.05). CONCLUSIONS: The study demonstrated that 1) in men older than 40 years, flow-mediated, endothelium-dependent vasodilation of the brachial artery was declined, 2) longer brachial artery occlusion resulted in more vasodilation despite similar hyperemic responses, 3) using low (30 mm Hg higher than systolic pressure) and high (70-90 mm Hg higher than systolic pressure) pressure, each pressure of occlusion was similar hyperemic response, and 4) in patients with essential hypertension, flow-medeiated vasodilation was significantly impaired and IMT was increased than in normotensive control subjects.
Adult* ; Arm ; Blood Pressure ; Brachial Artery ; Carotid Arteries ; Carotid Artery, Common ; Cholesterol ; Dilatation ; Endothelial Cells ; Female ; Humans ; Hyperemia ; Hypertension* ; Inflation, Economic ; Male ; Nitroglycerin ; Ultrasonography ; Vascular Diseases ; Vasodilation

Pseudoaneurysm is a rare life-threatening complication of chronic pancreatitis. It can be diagnosed by various imaging modalities including computerized tomography (CT), ultrasound, and angiography. Early diagnosis and radiologic or surgical treatment can promise better outcomes. However, pseudoaneurysm is not easily diagnosed. It can be misdiagnosed as a pseudocyst with secondary infection. Rarely, the correct diagnosis is made by an inadvertent trial with percutaneous drainage. The endoscopically identified hemosuccus pancreaticus is also a rare finding. Recently, we experienced two cases of pseudoaneurysm in patients with chronic pancreatitis. They did not have any evidence of bleeding in the initial endoscopy or evidence of pseudoaneurysms in the initial ultrasound and CT scan. In one case, the pseudoaneurysm was identified during a percutaneous drainage procedure, performed to diagnose and manage a cystic lesion which appeared to be an infected cyst. In the other case, the pseudoaneurysm was suspected after the hemosuccus pancreaticus was found during endoscopy performed due to recurrent hematemesis. Both cases were successfully treated with arterial embolization of the pseudoaneurysms.
Aneurysm, False* ; Angiography ; Coinfection ; Diagnosis ; Drainage* ; Early Diagnosis ; Endoscopy ; Hematemesis ; Hemorrhage ; Humans ; Pancreatitis, Chronic* ; Tomography, X-Ray Computed ; Ultrasonography

Endoscopic retrograde cholangiography has now evolved into a highly sophisticated diagnostic and therapeutic tool in patients with hepatobiliary-pancreatic disorders. However, this procedure is associated with risks of significant complications such as cholangitis, pancreatitis, hemorrhage, and perforation which have been widely recognized. Hepatic subcapsular biloma is a very rare and less recognized complication of this procedure. Recently, we experienced a case of hepatic subcapsular biloma, developed after endoscopic removal of choledocholithiasis, managed with percutaneous drainage procedure and endoscopic stenting, and report with a review of literature.
Cholangiography* ; Cholangitis ; Choledocholithiasis ; Drainage ; Hemorrhage ; Humans ; Pancreatitis ; Stents

BACKGROUND: In order to investigate the effects of intensive training on cardiorespiratory response to maximal exercise in soccer players, graded excercise stress tests were carried out before and after the training, and the results were compared. METHODS: Fourteen male soccer players of a university team with the mean age and career of 19.9 and 7.8 years, respectively, underwent intensive training for approximately 20 weeks, 6 days a week and 4 hours a day, which included running of 2 km daily during the last 8-9 weeks. The symptom-limited maximal exercise test was done by Bruce protocol. RESULTS: After the training. HR max showed no significant changes but Vo2 max, O2 pulse and AT were increased approximately 13%, 12% and 10%, respectively. At maximal exercise, the V(E)/M2 was also increased 18%, but VE/MVV was significantly decreased owing to a marked increase in MVV. However, the rest of various ventilatory parameters showed no significant changes. CONCLUSION: These data indicate that the intensive training of about 20 weeks duration can further improve the level of cardiorespiratory fitness in the soccer players who have been regularly trained and are already highly fit.
Exercise Test ; Humans ; Male ; Running ; Soccer*

MYH9-related disorder is an autosomal dominant disease caused by a mutation in the MYH9 gene, which encodes nonmuscle myosin heavy chain IIA (NMMHC-IIA). This disease is characterized by giant platelets, thrombocytopenia, granulocyte inclusion bodies, proteinuria, and high-pitch sensorineural deafness. Nephropathy has been observed in 30% of patients with MYH9-related disorder. The characteristic features are early onset proteinuria and rapidly progressing renal disorder. However, the prognosis of MYH9 nephropathy remains unclear. Herein, we describe a 36-year-old woman who presented with proteinuria and was diagnosed with MYH9 nephropathy via renal biopsy and gene analysis. Her proteinuria improved after administration of an angiotensin II receptor blocker, but was aggravated after changing to a calcium channel blocker.
Adult ; Albuminuria ; Biopsy ; Calcium Channels ; Deafness ; Female ; Granulocytes ; Humans ; Inclusion Bodies ; Myosin Heavy Chains ; Prognosis ; Proteinuria ; Receptors, Angiotensin ; Thrombocytopenia

BACKGROUND: Heme oxygenase-1 (HO-1) is known to modulates the cellular functions, including cell proliferation and apoptosis. It is known that a high level of HO-1 expression is found in many tumors, and HO-1 plays an important role in rapid tumor growth on account of its antioxidant and antiapoptotic effects. Cisplatin is a widely used anti-cancer agent for the treatment of lung cancer. However, the development of resistance to cisplatin is a major obstacle to its use in clinical treatment. We previously demonstrated that inhibiting HO-1 expression through the transcriptional activation of Nrf2 induces apoptosis in A549 cells. The aim of this study was to determine of the inhibiting HO-1 enhance the chemosensitivity of A549 cells to cisplatin. MATERIALS AND METHODS: The human lung cancer cell line, A549, was treated cisplatin, and the cell viability was measured by a MTT assay. The change in HO-1, Nrf2, and MAPK expression after the cisplatin treatment was examined by Western blotting. HO-1 inhibition was suppressed by ZnPP, which is a specific pharmacologic inhibitor of HO activity, and small interfering RNA (siRNA). Flow cytometry analysis and Western blot were performed in to determine the level of apoptosis. The level of hydrogen peroxide (H2O2) generation was monitored fluoimetrically using 2',7'-dichlorofluorescein diacetate. RESULTS: The A549 cells showed more resistance to the cisplatin treatment than the other cell lines examined, whereas cisplatin increased the expression of HO-1 and Nrf2, as well as the phosphorylation of MAPK in a time-dependent fashion. Inhibitors of the MAPK pathway blocked the induction of HO-1 and Nrf2 by the cisplatin treatment in A549 cells. In addition, the cisplatin-treated A549 cells transfected with dither the HO-1 small interfering RNA (siRNA) or ZnPP, specific HO-1 inhibitor, showed in a more significantly decrease in viability than the cisplatin-only-treated group. The combination treatment of ZnPP and cisplatin caused in a marked increase in the ROS generation and a decrease in the HO-1 expression. CONCLUSION: Cisplatin increases the expression of HO-1, probably through the MAPK-Nrf2 pathway, and the inhibition of HO-1 enhances the chemosensitivity of A549 cells to cisplatin.
Apoptosis ; Blotting, Western ; Cell Line ; Cell Proliferation ; Cell Survival ; Cisplatin* ; Flow Cytometry ; Heme Oxygenase-1* ; Heme* ; Humans ; Hydrogen Peroxide ; Lung Neoplasms* ; Lung* ; Phosphorylation ; RNA, Small Interfering ; Transcriptional Activation

OBJECTIVE: Aquaporin (AQP) 3 is a small integral membrane protein that functions as a facilitated transporter of water and glycerol. To elucidate a role of AQP3 in placenta, changes in amniotic fluid composition and fetal growth were investigated using AQP3 null mice. METHODS: Embryonic day 14,5 gestational sacs of wild-type and AQP3 kncok-out pregnant mice, thirty each, were used for this study. AQP3 localization and expression were assessed by immunohistochemistry and western blot. RESULTS: AQP3 was highly expressed in basolateral membrane of visceral yolk sac cells of fetal membrane and syncytiotrophoblast cells of labyrinthine placenta. In contrast, AQP1 was expressed in apical membrane of visceral yolk sac cells and endothelial cells lining vasculature. There was no significant difference in normal placentation and differentiation from trophoblast stem cells between wild type and AQP3 null mice. However, AQP3 null mice had increased amount of amniotic fluid per gram of body weight and decreased osmorality of amniotic fluid with low concentrations of ions and solutes in amniotic fluid. In addition, AQP3 null mice pups were smaller than CD1 wild type mice. CONCLUSION: AQP3 plays an important role in amniotic water balance and nutrient supply to developing fetus by facilitating transplacental transport of water and glycerol.
Amniotic Fluid ; Animals ; Blotting, Western ; Body Weight ; Endothelial Cells ; Extraembryonic Membranes ; Female ; Fetal Development ; Fetus ; Gestational Sac ; Glycerol ; Immunohistochemistry ; Ions ; Membrane Proteins ; Membranes ; Mice ; Placenta ; Placentation ; Stem Cells ; Trophoblasts ; Water ; Yolk Sac

PURPOSE: To compare immunogenicity and reactogenicity of a combined diphtheria-tetanus-acellular pertussis-inactivated poliovirus vaccine (DTPa-IPV, Infanrix(TM) IPV, GlaxoSmithKline Biologicals) with co-administration of commercially available DTPa and IPV vaccines at separate injection sites (DTPa+IPV). METHODS: A total of 458 infants aged 8-12 weeks were randomized to receive three-dose primary vaccination at 2, 4 and 6 months with DTPa-IPV or DTPa+IPV. Blood samples were collected pre and post vaccination for measurement of immune responses. Reactogenicity was assessed following each dose using diary cards. RESULTS: One month post-dose 3, seroprotection rates for anti-diphtheria, anti-tetanus and anti-poliovirus types 1, 2 and 3 were > or =99.5% and vaccine response rates to pertussis antigens were at least 98.6% in both DTPa-IPV and DTPa + IPV groups. Non-inferiority between the groups was demonstrated based on pre-defined statistical criteria. Incidences of both local and systemic symptoms were within the same range across both groups with grade 3 symptoms reported following no more than 4.3% of DTPa-IPV doses and 4.5% of DTPa + IPV doses. Two serious adverse events (both pyrexia) after DTPa-IPV administration were considered vaccine-related. Both infants recovered fully. CONCLUSION: Combined DTPa-IPV vaccine was immunogenic and well tolerated when used as a three-dose primary vaccination course in Korean infants. DTPa-IPV could be incorporated into the Korean vaccination schedule, reducing the number of injections required to complete primary immunization.
Aged ; Appointments and Schedules ; Humans ; Immunization ; Incidence ; Infant ; Pentetic Acid ; Poliovirus ; Vaccination ; Vaccines ; Whooping Cough