No abstract available.
Down Syndrome* ; Granulocyte Precursor Cells* ; Leukemia*

No abstract available.
Asphyxia* ; Brain Stem* ; Humans ; Infant, Newborn* ; Parturition*

BACKGROUND: To ensure patient safety and improvements in the quality of hospital care, rapid response teams (RRTs) have been implemented in many countries, including Korea. The goal of an RRT is early identification and response to clinical deterioration in patients. However, there are differences in RRT systems among hospitals and limited data are available. METHODS: In Seoul St. Mary's Hospital, the St. Mary's Advanced Life Support Team was implemented in June 2013. We retrospectively reviewed the RRT activation records of 287 cases from June 2013 to December 2016. RESULTS: The median response time and median modified early warning score were 8.6 minutes (interquartile range, 5.6 to 11.6 minutes) and 5.0 points (interquartile range, 4.0 to 7.0 points), respectively. Residents (35.8%) and nurses (59.1%) were the main activators of the RRT. Interestingly, postoperative patients account for a large percentage of the RRT activation cases (69.3%). The survival rate was 83.6% and survival was mainly associated with malignancy, Acute Physiology and Chronic Health Evaluation-II score, and the time from admission to RRT activation. RRT activation with screening showed a better outcome compared to activation via a phone call in terms of the intensive care unit admission rate and length of hospital stay after RRT activation. CONCLUSIONS: Malignancy was the most important factor related to survival. In addition, RRT activation with patient screening showed a better outcome compared to activation via a phone call. Further studies are needed to determine the effective screening criteria and improve the quality of the RRT system.
Epidemiology* ; Humans ; Intensive Care Units ; Korea ; Length of Stay ; Mass Screening ; Patient Safety ; Physiology ; Reaction Time ; Retrospective Studies ; Seoul ; Survival Rate

OBJECTIVE: The purpose of this study was to compare the changes induced in the pharyngeal airway space by orthodontic treatment with bodily retraction of the mandibular incisors and mandibular setback surgery without extraction. METHODS: This retrospective study included 63 adult patients (32 men and 31 women). Thirty-three patients who had been treated via four-bicuspid extraction and bodily retraction of the mandibular incisors (incisor retraction, IR group) were compared with 30 patients who had been treated via mandibular setback surgery (MS group) without extraction. Lateral cephalograms were acquired and analyzed before (T1) and after treatment (T2). RESULTS: The superior pharyngeal airway space did not change significantly in either group during treatment. The middle pharyngeal airway space decreased by 1.15 ± 1.17 mm and 1.25 ± 1.35 mm after treatment in the IR and MS groups, respectively, and the decrease was comparable between the two groups. In the MS group, the inferior pharyngeal airway space (E-IPW) decreased by 0.88 ± 1.67 mm after treatment (p < 0.01). The E-IPW was larger in the MS group than in IR group at T1, but it did not differ significantly between the two groups at T2. No significant correlation was observed between changes in the pharyngeal airway space and the skeletal and dental variables in each group. CONCLUSIONS: The middle pharyngeal airway space decreased because of the posterior displacement of the mandibular incisors and/or the mandibular body. The E-IPW decreased only in the MS group because of the posterior displacement of only the mandibular body.
Adult ; Humans ; Incisor* ; Male ; Retrospective Studies

Coronary artery dissection after blunt chest trauma is very rare conditon, and this can result in a serious acute myocardial infarction. We report a case of a 54-year old male who was presented with an anterior myocardial infarction after traffic accident, with steering wheel injury. His coronary angiography revealed a discrete eccentric 85% stenosis of proximal left anterior descending coronary artery with dissection and intravascular ultrasound showed a dissecting flap from the distal left main coronary artery to proximal left anterior descending coronary artery. He was successfully treated by percutaneous transluminal coronary angioplasty with stent.
Accidents, Traffic ; Angioplasty, Balloon, Coronary ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels* ; Humans ; Male ; Middle Aged ; Myocardial Infarction* ; Stents ; Thorax* ; Ultrasonography

BACKGROUND AND OBJECTIVES: Several randomized studies have shown that the implantable cardioverter-defibrillator (ICD) is a very effective treatment modality for the primary and secondary preventions of sudden cardiac death. The purpose of this study was to analyze our initial experience of ICD implantation in patients who had experienced syncope or sudden cardiac death between 1997 and 2004. SUBJECTS AND METHODS: Between Aug. 1997 and Feb. 2004, 28 patients who had undergone an ICD implantation at the Yonsei Cardiovascular Center were retrospectively analyzed. RESULTS: There were 28 patients (24 men, 4 female), with a mean age of 48+/-13.1 (21-74) years. ICD implantation was performed in 2 and 26 patients for the primary and secondary preventions of sudden cardiac death. Eight patients (28.6%) had neither a structural heart disease nor an electrical disease, but 8 (28.6%) had Brugada Syndrome. Twelve patients (42.8%) presented with structural heart disease. The most frequent documented clinical arrhythmia was ventricular fibrillation, which occurred in 11 patients (39.3%). During the mean follow-up of 29.3 months, the were 60 events of tachyarrhythmia triggered shock; 25 of these were from inappropriate shock due to atrial fibrillation (1 6), sinus tachycardia (6) and farfield T wave sensing (3). Two patients died: one of stomach cancer and the other died suddenly without DC shock. An autopsy revealed a moderate amount of bloody pericardial effusion, but unknown hemodynamic significance. CONCLUSION: The implant of an ICD is an effective measure for the secondary prevention of sudden cardiac death. Dual-chamber ICD is desirable for the prevention of inappropriate ICD shock for supraventricular tachyarrhythmias.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Autopsy ; Brugada Syndrome ; Death, Sudden, Cardiac ; Defibrillators, Implantable* ; Follow-Up Studies* ; Heart Diseases ; Hemodynamics ; Humans ; Male ; Pericardial Effusion ; Retrospective Studies ; Secondary Prevention ; Shock ; Stomach Neoplasms ; Syncope ; Tachycardia ; Tachycardia, Sinus ; Ventricular Fibrillation

Extramammary Paget's disease of the vulva is a rare intraepithelial neoplasm which is most commonly seen in postmenopausal Caucasian females. The most common presenting complaint is pruritis, vulvar pain, red eczematoid skin change. Treatment of Paget`s disease of the vulva requires wide local excision and if there is an underlying adenocarcinoma, radical vulvectomy with ipsilateral inguinal femoral lymphadenectomy is required. We experienced a case of extramammary Paget`s disease of the vulva, underwent radical vulvectomy with gluteal thigh flap and present with a brief review of literature.
Adenocarcinoma ; Carcinoma in Situ ; Female ; Humans ; Lymph Node Excision ; Paget Disease, Extramammary* ; Pruritus ; Skin ; Thigh* ; Vulva* ; Vulvar Neoplasms

BACKGROUND: Sinonasal infection is potentially a fatal disease in the immunocompromised patients who are undergoing bone marrow transplantation(BMT). OBJECTIVES: The aim of this study is to determine the incidence, symptoms and signs, risk factors, treatment modalities and the prognostic factors of the sinonasal infections in the immunocompromised BMT patients. MATERIALS AND METHODS: We reviewed the records of 235 patients who had received bone marrow transplantation in St. Mary's hospital from December 1983 to August 1995 to determine the clinical features of sinonasal infections in these patients. RESULTS: Forty six patients(19.6%) were affected by sinonasal infections. In 40 patients(17.0%) the infection occurred before BMT. In 11 patients(4.7%), the infection occurred after BMT. Five out of 11 patients(2.1%) had previous sinonasal infections. The most common symptoms and signs were fever and rhinorrhea. Fourteen patients had no discernible symptoms or signs that suggested the presence of sinonasal infection. In our study, patients with previous history of sinonasal infection were more likely to be infected again after BMT. Medical treatment with broad-spectrum antibiotics is the initial treatment modality and surgical treatment is indicated in intractable cases. CONCLUSIONS: The immunocompromised BMT patients have high incidence of serious sinonasal infections than normal immunocompetent persons. Early detection and aggressive combined treatment with medical and surgical modalities are essential for the treatment of sinonasal infections in the BMT patients.
Anti-Bacterial Agents ; Bone Marrow Transplantation* ; Bone Marrow* ; Fever ; Humans ; Immunocompromised Host* ; Incidence ; Risk Factors

PURPOSE: To assess whether the asymmetry in the peripapillary retinal nerve fiber layer (pRNFL) thickness between superior and inferior hemispheres on optical coherence tomography (OCT) is useful for early detection of glaucoma. MATERIALS AND METHODS: The patient population consisted of Training set (a total of 60 subjects with early glaucoma and 59 normal subjects) and Validation set (30 subjects with early glaucoma and 30 normal subjects). Two kinds of ratios were employed to measure the asymmetry between the superior and inferior pRNFL thickness using OCT. One was the ratio of the superior to inferior peak thicknesses (peak pRNFL thickness ratio; PTR), and the other was the ratio of the superior to inferior average thickness (average pRNFL thickness ratio; ATR). The diagnostic abilities of the PTR and ATR were compared to the color code classification in OCT. Using the optimal cut-off values of the PTR and ATR obtained from the Training set, the two ratios were independently validated for diagnostic capability. RESULTS: For the Training set, the sensitivities/specificities of the PTR, ATR, quadrants color code classification, and clock-hour color code classification were 81.7%/93.2%, 71.7%/74.6%, 75.0%/93.2%, and 75.0%/79.7%, respectively. The PTR showed a better diagnostic performance for early glaucoma detection than the ATR and the clock-hour color code classification in terms of areas under the receiver operating characteristic curves (AUCs) (0.898, 0.765, and 0.773, respectively). For the Validation set, the PTR also showed the best sensitivity and AUC. CONCLUSION: The PTR is a simple method with considerable diagnostic ability for early glaucoma detection. It can, therefore, be widely used as a new screening method for early glaucoma.
Area Under Curve ; Color ; Early Diagnosis ; Female ; Glaucoma/diagnosis ; Humans ; Male ; Mass Screening/methods ; Middle Aged ; Nerve Fibers/pathology ; ROC Curve ; Reproducibility of Results ; Retina/pathology ; Retinal Ganglion Cells ; Sensitivity and Specificity

Purpose: To investigate ocular surface diseases and changes in the quality of life of patients using glaucoma medications. Methods: Participants were divided into the normal (31 individuals, 62 eyes) and glaucoma medication (30 patients, 60 eyes) groups. Changes in tear break-up time, lipid layer thickness (LLT), corneal and conjunctival staining scores, ocular surface disease index (OSDI), and Visual Function Questionnaire 25 (VFQ-25) score were assessed for 1 year. Results: The change in mean LLT was lower in glaucomatous eyes than in control eyes (p = 0.019) after 1 year. The results of OSDI deteriorated (p’ = 0.008), but conjunctival staining and Schirmer test results showed improvement in glaucomatous eyes compared to those in control eyes (p’ =0.035 and 0.009, respectively). The average LLT decreased at 6 and 12 months, but there was no change at 24 months. In pairwise analysis, the decrease in LLT over the first 6 months was statistically significant (p < 0.001) and remained unchanged until 24 months. Among the VFQ items, scores for near activity and social function deteriorated over 1 year in the medication group (p’ = 0.033 and 0.015, respectively). However, there was no difference in the total VFQ score. Conclusions Significant reduction in LLT and deterioration of OSDI were observed in the medication group compared to the control group. However, this deterioration was observed only in the first 6 months. There was no significant difference in the VFQ total score. Nonetheless, there were significant differences in near activity and social function between the control and medication groups. Therefore, the results of this study showed that although glaucoma medication worsened eye dryness, the change was limited and did not worsen the quality of life. Glaucoma medication should be used with the consideration that they can limit near activity and social functioning.